jagdkampf
02-23-02, 07:09
Since I have started a thread on the difficult airway, perhaps we should discuss the management of the airway in general.
As we all know, in the ABC's of life support, A is airway and it's the first assessment we do. Is the airway open and is the patient breathing. BLS covers this in detail so I won't belabor it here. If you haven't taken BLS -- do so. Just about any Red Cross station offers it and it is money well spent even if they charge you a nominal fee. ACLS is even better if you can manage it. BLS is a precursor to ACLS.
When we encounter a need for medical intervention, we first examine the airway. If the patient is spontaneously breathing, exchanging air well and concious, we can continue on with a more detailed assessment. First things first, there is an old rule in health care -- "In any emergency, take you own pulse first". The gist of the statement being; you must be able to control your own enthusiasm for treating a patient. Far too many patients have been injured by over zealous practicioners to ignore this aspect of care. Do what is necessary at any given moment and no more than that. So, let's look at airways.
(1) The emergent airway -- This means that the patient is not breathing and needs help pronto. You do not have time for a detailed assessment here. Look for the obvious! Get the airway open and ventilate the patient. Techniques for doing this will be addressed in another thread.
(2) The urgent airway -- This most commonly manifests itself in a semiconcious patient and may only require minimal intervention such as repositioning the jaw or supporting the head and neck. In this case, the patient is spontaneously breathing and air is being exchanged but the patient may require assistance. If left unchecked, this may progress to an emergent airway. A good example of this would be an early drug overdose. The patient is lethargic and the respirations are labored, slow and noisy but the patient is responsive to stimuli. The patient needs intervention but may not need a full blown resuscitation at this point. Do what is necessary at the moment. Support the head and neck, clear the airway, observe the breathing, call for help. Keep talking to the patient and continue assessing the patient on a second by second basis. Be ready to proceed with emergent protocols if necessary.
(3) The non-emergent airway - The patient is breathing normally and seems to be exchanging well. Great! Nothing needs to be done here, right? Wrong. While the airway may not need immeadiate intervention, you still need to keep an eye on things. Let's use an example: Your point man on SAR has sustained a fall. He fell approximately 10 feet landing on his side. He is breathing, his color is good and exchanging air but he is complaining of difficulty breathing and thinks he has just had the "wind knocked out of him". Are we free and clear? Not yet. Potentially, he could have broken a rib. The rib could have punctured the pleura and he could be in the early stages of closed chest pneumothorax (collapsed lung). Continous assessment here is the key. He needs to be removed from the line, allowed to rest and recover and observed in detail. He should be observed a minimum of 30 minutes before being allowed to resume duties. During this time, he should be observed for changes in his condition. Generally, is he getting better or worse. How's his color, exchange of air? Is the pain worsening or lessening? He may have just had the "wind knocked out of him", but you need to make that determination and treat as necessary.
This whole airway thread will be interactive and I encourage you to add or question anything said here. Hopefully, when we get it all together, the administrators can put it in some coherent form and archive it. Any comments on this?
Jag
As we all know, in the ABC's of life support, A is airway and it's the first assessment we do. Is the airway open and is the patient breathing. BLS covers this in detail so I won't belabor it here. If you haven't taken BLS -- do so. Just about any Red Cross station offers it and it is money well spent even if they charge you a nominal fee. ACLS is even better if you can manage it. BLS is a precursor to ACLS.
When we encounter a need for medical intervention, we first examine the airway. If the patient is spontaneously breathing, exchanging air well and concious, we can continue on with a more detailed assessment. First things first, there is an old rule in health care -- "In any emergency, take you own pulse first". The gist of the statement being; you must be able to control your own enthusiasm for treating a patient. Far too many patients have been injured by over zealous practicioners to ignore this aspect of care. Do what is necessary at any given moment and no more than that. So, let's look at airways.
(1) The emergent airway -- This means that the patient is not breathing and needs help pronto. You do not have time for a detailed assessment here. Look for the obvious! Get the airway open and ventilate the patient. Techniques for doing this will be addressed in another thread.
(2) The urgent airway -- This most commonly manifests itself in a semiconcious patient and may only require minimal intervention such as repositioning the jaw or supporting the head and neck. In this case, the patient is spontaneously breathing and air is being exchanged but the patient may require assistance. If left unchecked, this may progress to an emergent airway. A good example of this would be an early drug overdose. The patient is lethargic and the respirations are labored, slow and noisy but the patient is responsive to stimuli. The patient needs intervention but may not need a full blown resuscitation at this point. Do what is necessary at the moment. Support the head and neck, clear the airway, observe the breathing, call for help. Keep talking to the patient and continue assessing the patient on a second by second basis. Be ready to proceed with emergent protocols if necessary.
(3) The non-emergent airway - The patient is breathing normally and seems to be exchanging well. Great! Nothing needs to be done here, right? Wrong. While the airway may not need immeadiate intervention, you still need to keep an eye on things. Let's use an example: Your point man on SAR has sustained a fall. He fell approximately 10 feet landing on his side. He is breathing, his color is good and exchanging air but he is complaining of difficulty breathing and thinks he has just had the "wind knocked out of him". Are we free and clear? Not yet. Potentially, he could have broken a rib. The rib could have punctured the pleura and he could be in the early stages of closed chest pneumothorax (collapsed lung). Continous assessment here is the key. He needs to be removed from the line, allowed to rest and recover and observed in detail. He should be observed a minimum of 30 minutes before being allowed to resume duties. During this time, he should be observed for changes in his condition. Generally, is he getting better or worse. How's his color, exchange of air? Is the pain worsening or lessening? He may have just had the "wind knocked out of him", but you need to make that determination and treat as necessary.
This whole airway thread will be interactive and I encourage you to add or question anything said here. Hopefully, when we get it all together, the administrators can put it in some coherent form and archive it. Any comments on this?
Jag