Safety First: Basic Airway

 


Study Notes:

  1. 1. Do they have a patent airway?

  2. 2. How good is it?

  3. 3. If absent or inadequate reposition head and use OPA/NPA's as necessary.

  4. 4.Be careful of the c-spine, but airway takes precedence over c-spine precautions.

  5. 5. If it’s good, move on to breathing

“Primary Airway”

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“Safety First” ... Table of Contents

Safety    Use your BSI - Biological Safety

              F is for Fire - Scene Safety

I                 I is for Incident: MOI/NOI          

R                Determine the numbeR of patients

S                Send for help

T                Trauma to the C-spine?

G                General impression of the patient

E                Estimate LOAs

T                Threats to you or your patient?

1°A             1° Airway

1°B             1° Breathing

1°C             1° Circulation

1°D             1° Decision

2°A             2° Airway

2°B             2° Breathing

2°C             2° Circulation

2°D             2° Decision

“ABC - Easy as 123...”

The first ‘A’ is for the airway and it directs you to: check that your patient’s airway is open, open it if it isn't, and then take some steps to ensure that it stays open.

However, before you go fiddling around repositioning someone's head in an attempt to open their airway, please take the time to ensure that their neck isn't broken! Obviously, we won’t be doing a full C-spine series of x rays, but if the scenario suggests trauma (i.e. an unresponsive patient in a car, air bags deployed, bent and bloody steering wheel, fractured jaw, etc.) then pay attention to it, and don't go jiggling their heads around.

The way we check if someone's airway is open is by aligning their head into the 'sniffing position' and checking to see if they are breathing. 


The sniffing position.
http://www.ems1.com/data/images/07-05fstcoam8.jpg.  April 2008.

To check this, we perform the ‘look, listen and feel’ maneuver that we all learned in first aid.

Obviously, if they are breathing, they must have an open (or 'patent' in medspeak) airway. If they aren't breathing, you have to attempt to ventilate them.

If you can get two breaths in - great, their airway is patient. If you can't, then you better figure out what is wrong really quickly.

To figure out what might be wrong if you can’t ventilate them, grab your suction kit and your airway equipment. Use your thumb and first finger to open their mouths up (trust me, if they're not breathing, they won't fight you on this - at least not for long anyway). If you can see an obstruction in their mouth then remove it with either the suction or forceps (if you have them). 

Be careful about sticking your fingers into an hypoxic patients mouth.  If the patient starts to seize, your gloves might have too many fingers for your hand.

If the patient originally had a patent airway, or if you have managed to make it patent, then make sure they stay in the 'sniffing position' and put in either a nasopharyngeal or oropharyngeal airway so that their tongue doesn't begin to block their airway. If they buck when you try and insert the airway then take it out - they don't need it.

Now they’ve got a patent airway - good job.  Next comes ‘B’, which stands for ...