As an Emergency Medical Responder, you must maintain an open airway to allow a free flow of air into and out of the patient's lungs. You must be familiar with the structures of the upper and lower airways. You must also understand the mechanisms of breathing.
One of the most important actions you can perform is to open the airway of an unresponsive patient. You must become familiar with the three main methods of opening an airway: (1) the head tilt-chin lift, (2) the jaw-thrust without head tilt maneuver, and (3) the tongue-jaw lift.
Remember that you must never use the head tilt-chin lift maneuver to open the airway if trauma to the head or neck is suspected. Damage to the patient's spinal cord can result.
When trauma to the head or neck of an unresponsive patient is suspected, use the jaw thrust without head tilt to open the patient's airway. This method of opening the airway is effective, but it is less effective than the head tilt-chin lift and is more tiring. Because this technique requires the use of both hands, a second rescuer will be needed if the patient requires ventilation.
The tongue-jaw lift requires no special equipment but it is difficult to maintain. Because a tongue-jaw lift also requires the use of both hands, a second rescuer will be needed if the patient requires ventilation. There is also a risk of exposure to infectious disease if your glove should tear on one of the patient's teeth.
If a patient's airway is obstructed, you must clear it. The three primary ways of clearing the airway of an unresponsive, injured patient are with the recovery position, finger sweeps, and suctioning.
You can use the recovery position as the first step in maintaining an open airway in an unresponsive patient. This position involves positioning a patient on his or her side. As an Emergency Medical Responder, you must become familiar with placing a patient in this position. You must also remember never to place a patient with a known or suspected spinal injury in the recovery position.
If you see foreign material in the patient's mouth, you must remove it immediately. Finger sweeps are used to remove material from an unresponsive patient's upper airway. A blind finger sweep is performed without first seeing foreign material in the airway. Remember that blind finger sweeps should never be performed on an infant or a child as they may cause the object to become further lodged in the patient's throat.
You should always have suction equipment available when you are managing a patient's airway or assisting a patient's breathing. Suctioning is a procedure used to vacuum vomitus, saliva, blood, food particles, and other material from the patient's airway. Suctioning may be needed if the recovery position and finger sweeps are not effective in clearing the patient's airway. It may also be needed if trauma is suspected and the patient cannot be placed in the recovery position.
After you have opened a patient's airway, you may need to use an airway adjunct to keep it open. After the airway adjunct is inserted, the proper head position must be maintained while the device is in place.
An oropharyngeal airway (OPA) is a device that is used only in unresponsive patients without a gag reflex. An OPA is inserted into the patient's mouth and used to keep the tongue away from the back of the throat.
A nasopharyngeal airway (NPA) is a device that is placed in the patient's nose. An NPA keeps the patient's tongue from blocking the upper airway. It also allows air to flow from the hole in the NPA down into the patient's lower airway.
After making sure that the patient's airway is open, you must check for breathing. If the patient is breathing, you must determine if the patient is breathing adequately or inadequately. You must also learn the sounds of noisy breathing, which include stridor, snoring, gurgling, and wheezing.
If your patient's breathing is inadequate or absent, you will need to assist the patient by forcing air into the patient's lungs. This action is called positivepressure ventilation and includes the following: mouth-to-mask ventilation, mouthto- barrier ventilation, mouth-to-mouth ventilation, and bag-valve-mask ventilation. As an Emergency Medical Responder, you will need to become familiar with performing all of these ventilation methods. You must also learn how to remove foreign body airway obstructions in patients of every age.
You may need to give patients supplemental oxygen. Become familiar with the features and functioning of oxygen cylinders. Remember always to keep combustible materials away from oxygen equipment and never position any part of your body over the cylinder.
The two most common oxygen delivery devices are the nonrebreather mask and the nasal cannula. In the field, the nonrebreather mask is the preferred method of oxygen delivery. It allows the delivery of high-concentration oxygen to a breathing patient. The nasal cannula is rarely the best method of delivering adequate oxygen in the field. It should be used only when patients will not tolerate a nonrebreather mask despite coaching.
