jagdkampf
02-23-02, 06:20
Now that we have looked at airway assessment and can get a general idea what we are faced with let's look at some of the tools we use to manage airways.
(1) The most basic is mouth to mouth resuscitation that we learn in BLS. It still works guys! In the field, you may not have many tools at your disposal but this still works. I won't go into the technique here as most of you probably know how to do this. If not, consult a first aid or BLS guidebook. They will cover it in detail. The biggest downside to this technique is exposure to body fluids and resultant infection and the potential for aspiration of stomach contents by the patient. The second is the delivery of sub normal oxygen percentages and high carbon dioxide percentages. The first pitfall we can avoid by carrying a pocket mask. This is a collapsible barrier mask that will easily fit in a jacket pocket, cargo pocket or backpack. This should be a mandatory part of your first aid kit. The second problem (low 02 - high co2), is not a problem we can do much about in the field. Just recognize the consequences. Delivery of low 02 and high co2 brings about a condition called acidosis. This is where the blood becomes more acidic than normal. It causes a host of bad things to happen. But if mouth to mouth is all you have -- use it.
(2) The Bag/Mask resuscitator - Most hospital providers and Paramedics/EMT's will recognize this device. It is basically an self inflating bag with an O2 port and resevoir connected to a mask. Given a supply of oxygen, you can deliver 100% O2 and diminish the risk of acidosis, if the patient has adequate circulation. It does not diminish the risk of aspiration but used properly it protects you from body fluids. While it is a little large for field transport, it can easily be placed in the trunk of your car or prepositioned in a remote field hospital. The bag/mask resuscitator is readily available on the surplus market and possibly through this board.
(3) The oropharyngeal airway - This a small curved plastic device that is placed in the mouth to provide a pathway for air to follow. It supports the tonque and keeps it from falling back and obstructing the airway. There are two general types, the Berman and Hudson type. It really doesn't make much difference which you use and they essentially look the same. I prefer the Hudson as it is softer and is easier on the teeth but whatever you can snag is fine. They come in different sizes (0 thru 5)or measured in millimeters (40 thru 105mm). 0 and 40mm are for infants, 5 and 105mm for large adults, and the other sizes for everybody in between. These are relatively compact and in my opinion, you should pack some of these with your pocket mask. Just carry the appropriate size for the party you are with. These are readily available on the surplus market. The technique for insertion is as follows: grasp the lower jaw and tonque between your thumb and forefinger, open the mouth and begin insertion with the curved/non flanged end into the mouth in a sideways position. As you advance the airway, turn it so that the curve is down toward the lower body. Make sure that you do not push the tonque back with the airway. Remove your fingers from the tonque and hold up on the chin firmly holding the airway in place with the teeth.
From this position, you can place your pocket mask over the nose and mouth and begin ventilation if necessary or use the bag/mask resuscitator. The disadvantages of the oropharyngeal airway are that they are not tolerated well by responsive patients and they do not prevent aspiration.
(4) The nasopharyneal airway - This is a small curved rubber tube with a flange on one end. It comes in several different sizes (usually 28 - 32mm). This is primarily intended for adult usage and is not generally recommended in the infant or pediatric population. While not as good as the oropharyngeal airway for manually ventilating a patient, it is better tolerated by a conscious or semiconcious patient and works pretty well for those patients who are spontaneously breathing and just need a little help opening the airway. It also works very well for patients who are clenching their teeth, i.e., seizure disorders. The technique for insertion is as follows: (1) lubricate the airway with KY jelly or water. (2) push gently up on the tip of the nose and look down the nose holes (nares), generally you will see the nasal septum in the midline. (3) put the non-flanged end of the airway into the nares that appears the most open with the curved end down toward the body. (4) push gently but firmly until the flange seats against the base of the nose. You should hear air passing through the tube. If you meet obstruction, stop and try the other nares.
The downside of this techniques is the potential for causing nosebleed. I generally spray my patient's nose with Afrin nasal spray prior to starting this but you may not have it in the field. Use good judgement and discretion here, you don't want to complicate a marginal airway with a nosebleed. No fun whatsover! Again, this does nothing to prevent aspiration.
This concludes what I consider the basic airway modalities. Next installment will cover intermeadiate airway modalites. Any questions?
Jag
(1) The most basic is mouth to mouth resuscitation that we learn in BLS. It still works guys! In the field, you may not have many tools at your disposal but this still works. I won't go into the technique here as most of you probably know how to do this. If not, consult a first aid or BLS guidebook. They will cover it in detail. The biggest downside to this technique is exposure to body fluids and resultant infection and the potential for aspiration of stomach contents by the patient. The second is the delivery of sub normal oxygen percentages and high carbon dioxide percentages. The first pitfall we can avoid by carrying a pocket mask. This is a collapsible barrier mask that will easily fit in a jacket pocket, cargo pocket or backpack. This should be a mandatory part of your first aid kit. The second problem (low 02 - high co2), is not a problem we can do much about in the field. Just recognize the consequences. Delivery of low 02 and high co2 brings about a condition called acidosis. This is where the blood becomes more acidic than normal. It causes a host of bad things to happen. But if mouth to mouth is all you have -- use it.
(2) The Bag/Mask resuscitator - Most hospital providers and Paramedics/EMT's will recognize this device. It is basically an self inflating bag with an O2 port and resevoir connected to a mask. Given a supply of oxygen, you can deliver 100% O2 and diminish the risk of acidosis, if the patient has adequate circulation. It does not diminish the risk of aspiration but used properly it protects you from body fluids. While it is a little large for field transport, it can easily be placed in the trunk of your car or prepositioned in a remote field hospital. The bag/mask resuscitator is readily available on the surplus market and possibly through this board.
(3) The oropharyngeal airway - This a small curved plastic device that is placed in the mouth to provide a pathway for air to follow. It supports the tonque and keeps it from falling back and obstructing the airway. There are two general types, the Berman and Hudson type. It really doesn't make much difference which you use and they essentially look the same. I prefer the Hudson as it is softer and is easier on the teeth but whatever you can snag is fine. They come in different sizes (0 thru 5)or measured in millimeters (40 thru 105mm). 0 and 40mm are for infants, 5 and 105mm for large adults, and the other sizes for everybody in between. These are relatively compact and in my opinion, you should pack some of these with your pocket mask. Just carry the appropriate size for the party you are with. These are readily available on the surplus market. The technique for insertion is as follows: grasp the lower jaw and tonque between your thumb and forefinger, open the mouth and begin insertion with the curved/non flanged end into the mouth in a sideways position. As you advance the airway, turn it so that the curve is down toward the lower body. Make sure that you do not push the tonque back with the airway. Remove your fingers from the tonque and hold up on the chin firmly holding the airway in place with the teeth.
From this position, you can place your pocket mask over the nose and mouth and begin ventilation if necessary or use the bag/mask resuscitator. The disadvantages of the oropharyngeal airway are that they are not tolerated well by responsive patients and they do not prevent aspiration.
(4) The nasopharyneal airway - This is a small curved rubber tube with a flange on one end. It comes in several different sizes (usually 28 - 32mm). This is primarily intended for adult usage and is not generally recommended in the infant or pediatric population. While not as good as the oropharyngeal airway for manually ventilating a patient, it is better tolerated by a conscious or semiconcious patient and works pretty well for those patients who are spontaneously breathing and just need a little help opening the airway. It also works very well for patients who are clenching their teeth, i.e., seizure disorders. The technique for insertion is as follows: (1) lubricate the airway with KY jelly or water. (2) push gently up on the tip of the nose and look down the nose holes (nares), generally you will see the nasal septum in the midline. (3) put the non-flanged end of the airway into the nares that appears the most open with the curved end down toward the body. (4) push gently but firmly until the flange seats against the base of the nose. You should hear air passing through the tube. If you meet obstruction, stop and try the other nares.
The downside of this techniques is the potential for causing nosebleed. I generally spray my patient's nose with Afrin nasal spray prior to starting this but you may not have it in the field. Use good judgement and discretion here, you don't want to complicate a marginal airway with a nosebleed. No fun whatsover! Again, this does nothing to prevent aspiration.
This concludes what I consider the basic airway modalities. Next installment will cover intermeadiate airway modalites. Any questions?
Jag