Basic Airway Management For Emergencies

Airway management ranks the most important in the management of trauma sufferers. often deaths occur due to the inability to recognize and deal with disorders of the patient's airway. Airway is a channel that functions to exchange air (oxygen and carbon dioxide) when breathing.

Disturbances that occur in the airway in the form of blockages that close the airways completely and partially. Airway handling is said to be successful if the obstruction in the airway can be handled quickly and accurately.

There are three ways that can be done to examine the airway, as follows
  1. look: see chest movements, reaction between ribs, skin mucosa color and patient awareness.
  2. Listen: hear the respiratory stream
  3. Feel: feel the breath coming out of the nose or mouth of the patient using a helper cheek.
Total blockage occurs due to a foreign object that closes the airway suddenly which is known as chocking.

As for the help method that can be done to help sufferers of total blockages known as choking are as follows.

Abdominal Thrust (Heimlich Maneuver)

Can be done in a standing and supine position. The trick is to give sudden beating to the pit of the stomach (subdiafragma - abdomen area).

Abdominal Thrust (Heimlich Maneuver) in a standing or sitting position

Here's how: the helper must stand behind the victim, circle the victim's waist with both of the helper's arms, then fist one hand and place the side of the fist's thumb on the victim's abdomen, just above the navel and below the tip of the sternum bone. Hold the fist tightly with the other hand. Press the fist into the stomach with a quick beat up. Every beat must be separate and clear movement.

Abdominal Thrust (Heimlich Maneuver) in a lying (unconscious) position

How: the victim must be placed in the supine position with face to face. The helper knelt on the side of the victim's thigh. Place one hand on the victim's abdomen in the midline slightly above the navel and far below the tip of the sternum bone, the second hand is placed above the first hand. The helper presses towards the abdomen with a rapid beat upwards. Based on the latest ILCOR, the method of abdominal thrust in the lying position is not recommended, it is recommended to immediately perform Lung Cardiac Resuscitation (CPR).
  
Abdominal Thrust (Heimlich Maneuver) on the self-carried out Self-help if you have airway obstruction.

How: Fist a hand, place the side of the thumb on the abdomen above the navel and under the tip of the sternum bone, hold the head firmly, put upward pressure towards the diaphragm with fast movements, if not successful can be done by pressing the stomach on table edge or back of the chair

Back Blow (for babies)

If the patient is aware, he can cough loudly, strict observation. If the breath is not effective or stop, do back blow 5 times (hard pounding on the victim's back at the cross point of the line between the shoulder blades and the spine / vertebrae)

Chest Thrust (for babies, obese children and pregnant women) 

If the patient is aware, do chest thrust 5 times (press the sternum with the index finger or middle finger about one finger below the imaginary line between the two patient's nipples). If the patient is conscious, sleep on his back, do chest thrust, pull the tongue if there is a foreign object, give artificial respiration.

partial blockages are divided into three parts, namely:

Blockage due to fluid

Every trauma patient has a risk of experiencing airway obstruction due to fluid caused by blood, secretions, saliva or from vomiting. blockage due to fluid can result in aspiration, namely the entry of foreign fluid into the lungs of the patient. Efforts to handle airway obstruction because of fluid can be done by suctioning as soon as possible. 

However suction action will suck up oxygen in the airway. therefore, pay attention to the maximum length of suction depending on the following age:
  1. for adults a maximum of 15 seconds 
  2. for children - a maximum of 5 seconds
  3. for babies a maximum of 3 seconds.
In certain cases suction action requires oxygenation before and after the action to prevent hypoxia. if the patient vomits in large numbers and the suction action does not help, then the head of the patient must be tilted.

Note: in trauma sufferers suspected of neck fractures (cervical fractures). then not only the neck is tilted but the whole body of the patient must be tilted "logroll"

Airway obstruction due to the base of the tongue

In patients who experience decreased consciousness, the base of the tongue may fall back and clog the hypopharynx. because the muscles supporting the tongue are limp or paralyzed.how to overcome the obstruction of the airway because the base of the tongue in principle is to lift the tongue's spinal cord so as not to cause the airway.

Here are some ways to overcome the blockage due to the base of the tongue
  • The head tilt chin lift  maneuver, 

This method was chosen in patients with no suspicion of cervical fracture. the way is by lifting your chin and raising your head.
  • Chin lift maneuver, 

This method is chosen in trauma patients or suspicious of cervical fractures. the way is by placing the fingers of one hand under the jaw, which is then carefully lifted up to bring the chin forward. the same thumb, lightly pressing the lower lip to open the mouth. The thumb can also be placed behind the lower incisors and simultaneously, the chin is carefully removed. Chin lift maneuvers should not cause neck hyper extension.
  • jaw trust maneuver,  

May be performed in patients suspected of cervical fractures. how to hold the angle of the lower jaw (angular mandibulae) left and right, then push the lower jaw upwards, with the jaw pushed upwards the airway can open. the helper's position is at the top of the head.
  • Installation of Oro pharingeal airway (OPA)

This action is to free the airway obstruction by inserting a tool into the mouth (behind the tongue) by holding the patient's tongue so as not to clog the airway.

General oro pharyngeal airways (OPA) installation techniques.
  1. always maintain servical immobilization in patients with suspected cervical fractures.
  2. select a suitable OPA size, by measuring it according to the angle of the mouth to the patient's external auditivus.
  3. open the patient's mouth with a Chin lift maneuver or cross finger technique (scissor tchnique).
  4. insert the tangue on the patient's tongue, far enough to press the tongue
  5. insert the posterior OPA gently gliding over the tongue until the retaining wing stops at the patient's lips.
  6. OPA should not push the tongue so that it clogs the airway
  7. pull tongue spatel
  8. OPA should not be plastered to prevent vomiting stimulation in patients who experience an increased status of consciousness.
  •  Naso pharyngeal airway (NPA) installation

This action is done by inserting a tool in one of the nostrils and passing it carefully to the posterior oropharynx. in patients who still have a response, the installation of NPA is more appropriate than OPA because it is smaller in causing vomiting stimulation.

General NPA Installation Techniques
  1. select the appropriate NPA size, the length of the NPA is measured from the nostril to the ear and the diameter of the NPA is measured by comparing the NPA with the little finger of the patient.
  2. lubricate NPA with jelly to easily insert it.
  3. enter the NPA through the right nostril, along the septal wall to the specified size. if there are prisoners pull back and try to enter it again through the nostril next to it. but if there are still prisoners do not force to enter the NPA.
  4. careful installation of NPA in suspicion of cranial base fracture, because there is a possibility of entering the skull cavity.
Anatomical blockage

Anatomical blockage is caused by respiratory tract disease (eg diphtheria) or due to trauma that causes swelling of the airway (eg inhalation trauma) in fires or blunt trauma to the neck.anatomical blockage handling often requires surgical treatment by making an alternative airway without the patient's mouth or nose.

Source: Basic Trauma Life Support (BTLS) Pro Emergency

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