Emergency Medical Response

You Are the Emergency Medical Responder

As border security in the immediate vicinity and trained as an emergency medical responder (EMR), you respond to a call at one of the docks for an unconscious adult who collapsed for no apparent reason. You size-up the scene and notice that a middle-age male is lying prone on the floor and not moving. You discover that the patient’s chest does not rise when you attempt ventilations.

Lesson 15: Airway Management

Emergency Medical Response

Suctioning

Use of sterile suction catheters of appropriate size Airflow of >40 LPM at end of delivery tube Vacuum of >300 mmHg when clamped

Process of removing foreign matter, such as mucus, fluid or blood, from a patient’s upper airway

Two types of devices• Mechanical: electrically

powered• Manual: hand powered; no energy source

Emergency Medical Response

Airway Adjuncts

Mechanical airway adjuncts• Oral (Oropharyngeal)

airways (OPAs)• Nasal (Nasopharyngeal) airways (NPAs)

They keep the tongue (the most common cause of airway obstruction) away from the back of the throat.

OPAs are only for unconscious, unresponsive patients without a gag reflex.

Emergency Medical Response

Airway Obstructions

Anatomical obstruction from―• The tongue• Swollen tissues of the mouth, tongue or throat

Mechanical obstruction from―• Foreign objects, such as food or toys• Fluids, such as vomit

Emergency Medical Response

Foreign Body Airway Obstruction

Universal sign: a conscious person who is clutching the throat

Mild or partial FBAO• Ability to move some air to and from the lungs• Forcibly coughing, which is encouraged

Severe FBAO• Inability to cough, speak, cry or breathe• Immediate action is necessary

Emergency Medical Response

Measures to Relieve FBAO

Conscious patient• Continued forcible coughing• Back blows• Abdominal thrusts (adults and children)• Chest thrusts (for infants, pregnant women and

patients too large to reach around) Unconscious patient

• Chest compressions• Finger sweep if object is visible in the mouth

Emergency Medical Response

Scenario

While attending a picnic, you notice that a 4-year-old boy begins coughing very forcibly while eating a hot dog. His mother appears frantic and begins shouting for help. As a trained EMR, you respond to the mother’s call for help.

Emergency Medical Response

You Are the Emergency Medical Responder

You reposition the patient’s airway and attempt 2 ventilations, but the chest still does not rise.

After a few minutes of care, the patient’s chest begins to rise and fall with the ventilations, but he is not breathing on his own.

Emergency Medical Response

Nasal Airway

Uses• Conscious, responsive patient• Unconscious patient

Contraindications for use• Suspected head trauma• Suspected skull fracture

Lubrication of airway with water-soluble lubricant is necessary

Insertion with bevel of airway toward septum