Wednesday, February 10, 2016

Wilderness or Grid Down Medical Skills 3: Establishing An Airway

Medical training is serious and should be given by competent medical professionals. This article and the whole medical series is not medical advice. It is for informational purposes only. Find good medical training in your area before actually doing the procedures in this series.
This is a series designed to give you a basic medical knowledge of what I consider medical skills you should have if there is no help in sight. The skills are:
Broken bones
Establishing an airway
Deliver a baby
Know The Symptoms of a Heart Attack, Heat Exhaustion or a Stroke
Basic Wound Dressing Techniques

Establishing an airway
This doesn’t necessarily mean jabbing a hollow pen in someone’s neck, although this could become necessary in a extreme situation. There are basic ways of trying to establish an airway. l
Airway management must be rapid and effective for the patient to survive. A stepwise approach to airway management, starting with the simplest and most rapidly applied, will ensure that the best method for securing the airway is used.
To live and function properly every cell must receive a continuous supply of oxygen, and waste products must be removed. This process can be interrupted if the air passages become obstructed.
Patients requiring resuscitation often have an obstructed airway which may be the cause or the result of unconsciousness. This obstruction can be partial or complete and can affect the upper or lower respiratory tract, or both.
Common causes of airway obstruction are:
• the relaxed tongue falling back in the throat;
• foreign material, such as blood, vomit, saliva,
• displaced dentures,
• food,
• small toys,
• pulmonary hemorrhage;
The relaxed tongue is the most common obstruction but good manual airway techniques can manage the problem, suction and patient positioning can assist in removing foreign material and choking procedures can remove foreign objects.
Airway obstruction can be recognized by the look, listen and feel approach.
1. look for chest and abdominal movements
2. listen and feel for airflow at the mouth and nose.
In partial airway obstruction, air entry is reduced and usually noisy. Expiratory wheeze suggests an obstruction of the lower airways which tend to collapse and obstruct during expiration. Other sounds include: gurgling − suggesting the presence of liquids or semi-solid material in the airways, such as blood or vomit; and snoring − arising from the airway being partially occluded by the tongue or palate.
Complete airway obstruction in a patient who is making respiratory effort results in observing chest and abdominal movement. As the patient tries to inhale, the chest is drawn in and the abdomen expands, with the opposite happening during expiration.
Once any degree of obstruction is recognized, immediate measures should be taken to maintain a clear airway.
Opening an airway
Manual methods of airway control are:

1. Head tilt, chin lift in non-traumatic situations;
2. Jaw thrust. This is the technique of choice with patients with suspected cervical spine injuries
These simple positional methods are successful in most cases where the obstruction is the result of relaxation of the tongue and soft tissues. After each maneuver check for success using the look, listen and feel sequence. If a clear airway cannot be achieved, other causes of airway obstruction must be taken care of.
These are basic CPR ideas. Take a CPR class and stay qualified. Even if you don’t take a refresher course often, review the CPR steps and you can even practice them to a certain degree.
Be familiar with doing a Tracheotomy.
This procedure, technically called a cricothyroidotomy, should be undertaken only when a person with a throat obstruction is not able to breathe at all-no gasping sounds, no coughing-and only after you have attempted to perform the Heimlich maneuver three times without dislodging the obstruction. If possible, someone should call for paramedics while you proceed.
What you will need
A first aid kit, if available
A razor blade or very sharp knife
A straw (two would be better) or a ballpoint pen with the inside (ink-filled tube) removed. If neither a straw nor a pen is available, use stiff paper or cardboard rolled into a tube. Good first aid kits may contain "trache" tubes.
There will not be time for sterilization of your tools, so do not bother; infection is the least of your worries at this point.
How to Proceed
1. Find the person's Adam's apple (thyroid cartilage).
2. Move your finger about one inch down the neck until you feel another bulge. This is the cricoid cartilage. The indentation between the two is the cricothyroid membrane, where the incision will be made.
3. Take the razor blade or knife and make a half-inch horizontal incision. The cut should be about half an inch deep. There should not be too much blood.
4. Pinch the incision open or place your finger inside the slit to open it.
5. Insert your tube in the incision, roughly one-half to one inch deep.
6. Breathe into the tube with two quick breaths. Pause five seconds, then give one breath every five seconds.
7. You will see the chest rise and the person should regain consciousness if you have performed the procedure correctly. The person should be able to breathe on their own, albeit with some difficulty, until help arrives.
Remember, a tracheotomy is an extreme-case procedure. Do this only if you feel there is no other way to restore the airway. I do not recommend doing a tracheotomy but have included instructions because the need could arise. This is best done with medical help available. Any type of procedure that is extreme can cause additional damage or infection and those risks should be considered. But doing this procedure is desirable over death.
May I wimp out one more time and say that I am not a doctor or healthcare professional. This is information I have found to be part of an end-of-the-world scenario and not for normal day use. Seek professional medical help always if possible.
Semper Paratus
Check 6