Airway Management
Watch a video # 2 video
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
In the tactical field care phase, direct initial management to the evaluation and treatment of the casualty’s airway once all hemorrhage problems have been addressed.
Intervention should proceed from the least invasive procedure to the most invasive.
Do not attempt any airway intervention if the casualty is conscious and breathing well on his own.
Allow the casualty to assume the most comfortable position that best protects his airway, to include sitting upright.
Unconscious casualty without airway obstruction.
If the casualty is unconscious, the most likely cause is either hemorrhagic shock or head trauma.
In either case, an adequate airway must be maintained.
If the unconscious casualty does not exhibit signs of airway obstruction, the airway should first be opened with a chin lift or a jaw-thrust maneuver.
As in the care under fire phase, cervical spine immobilization is generally not required, except in the instance of significant blunt trauma.
If spontaneous respirations are present without respiratory distress, an adequate airway in the unconscious casualty is best maintained with a nasopharyngeal airway (NPA).
An NPA is preferred over an oropharyngeal airway because it is better tolerated if the casualty regains consciousness and is less likely to be dislodged during casualty transport.
After inserting the NPA, place the casualty in the recovery position (see Figure 1-1) to maintain the open airway and prevent aspiration of blood, mucous, or vomit.
Figure 1-1. Recovery position
Current or impending airway obstruction.
For casualties with a current or impending airway obstruction, the initial intervention is again to open the airway with either a chin lift or a jaw-thrust maneuver. Either maneuver is followed by the insertion of an NPA.
However, if an airway obstruction develops or persists despite the use of an NPA, a more definitive airway is required.
In some casualties a more definitive airway may consist of a supraglottic device, such as a combitube or King LT.
These airways are not well tolerated unless the casualty is totally obtunded.
These devices are easily inserted and able to maintain an open airway better than a simple NPA.
However, often a surgical cricothyroidotomy may be indicated. Cricothyroidotomy. Significant airway obstruction in the combat setting is likely the result of penetrating wounds of the face or neck, where blood or disrupted anatomy precludes good visualization of the vocal cords.
This setting makes endotracheal intubation highly difficult, if not impossible.
In these cases, surgical cricothyroidotomy is preferable over endotracheal intubation.
This procedure has been reported safe and effective in trauma victims, and in the hands of a rescuer who does not intubate on a regular basis, it should be the next step when other airway devices are not effective.
Furthermore, cricothyroidotomy can be performed under local anesthesia with lidocaine on a casualty who is awake.
The majority of preventable airway deaths occurred from penetrating trauma to the face and neck, where disrupted anatomy and significant bleeding made airway interventions very difficult.
Intubation.
Endotracheal intubation is the preferred airway technique in civilian trauma settings, but this procedure may be prohibitively difficult in the tactical environment.
Many medics have never intubated a live person; their experience is only with mannequins in a controlled environment and is infrequent at best.
The standard endotracheal intubation technique requires the use of tactically compromising white light.
Also, esophageal intubations are more likely with the inexperienced intubator and much more difficult to detect in the tactical environment.
Finally, most airway obstructions on the battlefield are the result of penetrating wounds of the head and neck, where cricothyroidotomy is the procedure of choice.
Breathing
The next aspect of casualty care in the tactical field care phase is the treatment of any breathing problems, specifically the development of either an open PTX or a tension PTX.
Penetrating chest wounds. Traumatic defects in the casualty’s chest wall may result in an open PTX. All open chest wounds should be treated as such.
Cover the wound during expiration with an occlusive dressing; numerous different materials are available for use.
In addition, multiple commercial chest seals are now available, many with excellent adhesive properties.
The dressing should be sealed on all four sides. The casualty should then be placed in a sitting position, if applicable, and monitored for the development of a tension PTX, which should be treated as described next
Watch a video # 2 video
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
In the tactical field care phase, direct initial management to the evaluation and treatment of the casualty’s airway once all hemorrhage problems have been addressed.
Intervention should proceed from the least invasive procedure to the most invasive.
Do not attempt any airway intervention if the casualty is conscious and breathing well on his own.
Allow the casualty to assume the most comfortable position that best protects his airway, to include sitting upright.
Unconscious casualty without airway obstruction.
If the casualty is unconscious, the most likely cause is either hemorrhagic shock or head trauma.
In either case, an adequate airway must be maintained.
If the unconscious casualty does not exhibit signs of airway obstruction, the airway should first be opened with a chin lift or a jaw-thrust maneuver.
As in the care under fire phase, cervical spine immobilization is generally not required, except in the instance of significant blunt trauma.
If spontaneous respirations are present without respiratory distress, an adequate airway in the unconscious casualty is best maintained with a nasopharyngeal airway (NPA).
An NPA is preferred over an oropharyngeal airway because it is better tolerated if the casualty regains consciousness and is less likely to be dislodged during casualty transport.
After inserting the NPA, place the casualty in the recovery position (see Figure 1-1) to maintain the open airway and prevent aspiration of blood, mucous, or vomit.
Figure 1-1. Recovery position
Current or impending airway obstruction.
For casualties with a current or impending airway obstruction, the initial intervention is again to open the airway with either a chin lift or a jaw-thrust maneuver. Either maneuver is followed by the insertion of an NPA.
However, if an airway obstruction develops or persists despite the use of an NPA, a more definitive airway is required.
In some casualties a more definitive airway may consist of a supraglottic device, such as a combitube or King LT.
These airways are not well tolerated unless the casualty is totally obtunded.
These devices are easily inserted and able to maintain an open airway better than a simple NPA.
However, often a surgical cricothyroidotomy may be indicated. Cricothyroidotomy. Significant airway obstruction in the combat setting is likely the result of penetrating wounds of the face or neck, where blood or disrupted anatomy precludes good visualization of the vocal cords.
This setting makes endotracheal intubation highly difficult, if not impossible.
In these cases, surgical cricothyroidotomy is preferable over endotracheal intubation.
This procedure has been reported safe and effective in trauma victims, and in the hands of a rescuer who does not intubate on a regular basis, it should be the next step when other airway devices are not effective.
Furthermore, cricothyroidotomy can be performed under local anesthesia with lidocaine on a casualty who is awake.
The majority of preventable airway deaths occurred from penetrating trauma to the face and neck, where disrupted anatomy and significant bleeding made airway interventions very difficult.
Intubation.
Endotracheal intubation is the preferred airway technique in civilian trauma settings, but this procedure may be prohibitively difficult in the tactical environment.
Many medics have never intubated a live person; their experience is only with mannequins in a controlled environment and is infrequent at best.
The standard endotracheal intubation technique requires the use of tactically compromising white light.
Also, esophageal intubations are more likely with the inexperienced intubator and much more difficult to detect in the tactical environment.
Finally, most airway obstructions on the battlefield are the result of penetrating wounds of the head and neck, where cricothyroidotomy is the procedure of choice.
Breathing
The next aspect of casualty care in the tactical field care phase is the treatment of any breathing problems, specifically the development of either an open PTX or a tension PTX.
Penetrating chest wounds. Traumatic defects in the casualty’s chest wall may result in an open PTX. All open chest wounds should be treated as such.
Cover the wound during expiration with an occlusive dressing; numerous different materials are available for use.
In addition, multiple commercial chest seals are now available, many with excellent adhesive properties.
The dressing should be sealed on all four sides. The casualty should then be placed in a sitting position, if applicable, and monitored for the development of a tension PTX, which should be treated as described next
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