Life Saving measures in any emergency situation is described under the acronym ABCD.
Life Saving measures in any emergency situation is described under the acronym ABCD.
“A” stands for airway. Unless the airway is patent breathing (B) will not be adequate or possible and this will undoubtedly lead to cardiac (C) circulatory problems. If the airway problem is taken care of, most of the emergency situations could be avoided.
The problems that interfere with airway is obstruction to the passage anywhere from the nostrils down to the larynx and trachea by any one of the processes described below. It causes limitation of air entry into the lungs resulting in hypoxia leading to death.The airway is normally protected by the patient’s ability to swallow or cough out and clear nasopharyngeal, oropharyngeal and tracheal secretions. However, in an unconscious patient when these reflexes do not function well, these protective mechanisms will not be available.Obstruction to airway is caused by :
1. Tongue falling backwards obstructing the oropharynx in an unconscious patient
2. Secretions that collect in the oropharynx in an unconscious patient who is not able to clear it
3. The stomach contents being aspirated into larynx and trachea and filling up the oropharynx
4. Facial injuries resulting in nasopharyngeal trauma causing continuous oozing of blood and clots causing obstruction to the nasopharynx and oropharynx.
5. Foreign bodies inadvertently aspirated into larynx and trachea resulting in acute obstruction (dentures)
6. Anesthetic agents and toxic substances ingested or inhaled causing the loss of gag reflux.
7. Any unconscious status – coma due to disease or drugs – anesthesia, seizure disorders – Electro convulsive therapy etc.
Irrespective of the cause of obstruction the effect is the same. The family physician and the first contact person should be able to do a few basic preliminary procedures that would prevent disastrous results due to airway obstruction.
Warning
In any patient who has sustained multiple trauma or had a fall from heights or has head injury, it is always better to suspect injury to the cervical spine and he/she has to be handled carefully in such a manner that the neck is not manipulated or extended and appropriate neck support provided.
Airway management
The first step, which most often helps the patient in managing airway, is to maintain him in a supine posture. In this position the whole body could be tilted to one side like a log to provide drainage from the mouth to gravitate out. When there is no suspicion of neck injury this could be accomplished just by turning the head to one side.
The next step is to make sure that all foreign bodies and secretions are removed from the back of the throat. The jaw can be lifted with a thumb inside the oral cavity pressing on the tongue and the other fingers protecting the chin with the left hand.
The right hand index and middle fingers (gloved) is swept inside the mouth and with a swooping movement foreign bodies and secretions in the oropharynx are brought out. This is followed by adequate suctioning of the oropharynx to clear of secretions, aspirates from the stomach, foreign bodies etc. If the tongue is flopping backwards applying a tongue forceps to the anterior tongue this can be drawn forward to provide direct airway without obstruction.
Opening the airway : Jaw Thrust Method
Grasp the angles of the Jaw with both hands and displace the mandible forwards. This clears obstruction by tongue and opens Airway Passage.
B – Opening the airway: Chin lift method
Fingers of one hand placed under the mandible and gently lift the chin forwards. The lower lip is depressed with the thumb to open the mouth.
C – Oropharyngeal airway
Requirement:
1. Tongue depressor (blade)
2. Selected appropriate size airway (incisor teeth to angle of the mandible)
3. Suction machine if available.
Procedure:
Chin lift – open mouth
Depress tongue with blade
Insert airway backwards gently sliding over the curvature of tongue
Airway flange should be out of the mouth.
Remove tongue blade and secure airway.
Suction as necessary.
Face mask and ventilation as necessary
D – Nasopharyngeal airway
Ideal when patient is somewhat conscious – better tolerated than oropharyngeal.
Requirements:
1. Appropriate size Nasopharyngeal airway (Nostril to pharynx size)
2. Lubricant ((K.Y. Jelly)
Procedure:
Select the nostril that is not obstructed. Lubricate the airway selected and
Gently insert the tip through the nostril and slowly advance the same towards the ear with a gentle rotary movement till the flange comes in contact with the external nostril (Now it is in hypopharynx)..
Face mask ventilation as necessary
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