| 2-12.
Airway Obstructions
In order for oxygen from the air to flow to and from
the lungs, the upper airway must be unobstructed.
a. Upper airway obstructions
often occur because—
(1) The casualty’s tongue falls back into his throat while
he is unconscious as a result of injury, cardiopulmonary arrest, and so forth.
(The tongue falls back and obstructs, it is not swallowed.)
(2) Foreign
bodies become lodged in the throat. These obstructions usually occur while eating
(meat most commonly causes obstructions). Choking on food is associated with—
•
Attempting to swallow large pieces of poorly chewed food.
• Drinking alcohol.
•
Slipping dentures.
(3) The contents of the stomach are regurgitated and may
block the airway.
(4) Blood clots may form as a result of head and facial injuries.
b.
Upper airway obstructions may be prevented by taking the following precautions:
(1)
Cut food into small pieces and take care to chew slowly and thoroughly.
(2)
Avoid laughing and talking when chewing and swallowing.
(3) Restrict alcohol
while eating meals.
(4) Keep food and foreign objects from children while they
walk, run, or play.
(5) Consider the correct positioning/maintenance of the
open airway for the injured or unconscious casualty.
c. Upper airway
obstruction may cause either partial or complete airway blockage.
*(1)
Partial airway obstruction. The casualty may still have an air exchange. A
good air exchange means that the casualty can cough forcefully, though
he may be wheezing between coughs. You, the rescuer, should not interfere, and
should encourage the casualty to cough up the object on his own. A poor air
exchange may be indicated by weak coughing with a high pitched noise between
coughs. Additionally, the casualty may show signs of shock (for example,
paleness of the skin, bluish or grayish tint around the lips or fingernail beds)
indicating a need for oxygen. You should assist the casualty and treat him as
though he had a complete obstruction.
(2) Complete airway obstruction.
A complete obstruction (no air exchange) is indicated if the casualty cannot speak,
breathe, or cough at all. He may be clutching his neck and moving erratically.
In an unconscious casualty a complete obstruction is also indicated if after opening
his airway you cannot ventilate him. 2-13.
Opening the Obstructed Airway-Conscious Casualty (081-831-1003)
Clearing
a conscious casualty’s airway obstruction can be performed with the casualty either
standing or sitting, and by following a relatively simple procedure. WARNING
Once
an obstructed airway occurs, the brain will develop an oxygen deficiency resulting
in unconsciousness. Death will follow rapidly if prompt action is not taken. a.
Step ONE. Ask the casualty if he can speak or if he is choking. Check for
the universal choking sign (Figure 2-18).
b.
Step TWO. If the casualty can speak, encourage him to attempt to cough; the
casualty still has a good air exchange. If he is able to speak or cough
effectively, DO NOT interfere with his attempts to expel the obstruction.
c.
Step THREE. Listen for high pitched sounds when the casualty breathes or coughs
(poor air exchange). If there is poor air exchange or no breathing, CALL for HELP
and immediately deliver manual thrusts (either an abdominal or chest thrust). NOTE
The
manual thrust with the hands centered between the waist, and the rib cage is called
an abdominal thrust (or Heimlich maneuver). The chest thrust (the hands are centered
in the middle of the breastbone) is used only for an individual in the advanced
stages of pregnancy, in the markedly obese casualty, or if there is a significant
abdominal wound. •
Apply ABDOMINAL THRUSTS using the procedures below:
º Stand behind
the casualty and wrap your arms around his waist. Make a fist with one hand and
grasp it with the other. The thumb side of your fist should be against the casualty’s
abdomen, in the midline and slightly above the casualty’s navel, but well below
the tip of the breastbone (Figure 2-19).
º
Press the fists into the abdomen with a quick backward and upward thrust (Figure
2-20).
o
Each thrust should be a separate and distinct movement.
*NOTE
Continue performing abdominal thrusts until the obstruction is expelled
or the casualty becomes unconscious. o
If the casualty becomes unconscious, call for help as you proceed with steps to
open the airway and perform rescue breathing (See task 081-831-1042, Perform
Mouth-to-Mouth Resuscitation.)
• Applying CHEST THRUSTS. An alternate technique
to the abdominal thrust is the chest thrust. This technique is useful when the
casualty has an abdominal wound, when the casualty is pregnant, or when the casualty
is so large that you cannot wrap your arms around the abdomen. To apply chest
thrusts with casualty sitting or standing:
o Stand behind the casualty and
wrap your arms around his chest with your arms under his armpits.
o Make a
fist with one hand and place the thumb side of the fist in the middle of the breastbone
(take care to avoid the tip of the breastbone and the margins of the ribs).
o
Grasp the fist with the other hand and exert thrusts (Figure 2-21).
º
Each thrust should be delivered slowly, distinctly, and with the intent of relieving
the obstruction.
o Perform chest thrusts until the obstruction is expelled
or the casualty becomes unconscious.
o If the casualty becomes unconscious,
call for help as you proceed with steps to open the airway and perform rescue
breathing. (See task 081-831-1042, Perform Mouth-to-mouth Resuscitation.) 2-14.
Open an Obstructed Airway—Casualty Lying or Unconscious (081-831-1042)
The
following procedures are used to expel an airway obstruction in a casualty who
is lying down, who becomes unconscious, or is found unconscious (the cause unknown):
•
If a casualty who is choking becomes unconscious, call for help, open the airway,
perform a finger sweep, and attempt rescue breathing (paragraphs 2-2 through 2-4).
If you still cannot administer rescue breathing due to an airway blockage, then
remove the airway obstruction using the procedures in steps a through e below.
•
If a casualty is unconscious when you find him (the cause unknown), assess or
evaluate the situation, call for help, position the casualty on his back, open
the airway, establish breathlessness, and attempt to perform rescue breathing
(paragraphs 2-2 through 2-8).
a. Open the airway and attempt rescue
breathing. (See task 081-831-1042, Perform Mouth-to-mouth Resuscitation.)
b.
If still unable to ventilate the casualty, perform 6 to 10 manual (abdominal or
chest) thrusts. (Note that the abdominal thrusts are used when casualty does not
have abdominal wounds; is not pregnant or extremely overweight.) To perform the
abdominal thrusts:
(1) Kneel astride the casualty’s thighs (Figure 2-22).
(2)
Place the heel of one hand against the casualty’s abdomen (in the midline slightly
above the navel but well below the tip of the breastbone). Place your other hand
on top of the first one. Point your fingers toward the casualty’s head.
(3)
Press into the casualty’s abdomen with a quick, forward and upward thrust. You
can use your body weight to perform the maneuver. Deliver each thrust slowly and
distinctly.
(4) Repeat the sequence of abdominal thrusts, finger sweep, and
rescue breathing (attempt to ventilate) as long as necessary to remove the object
from the obstructed airway. See paragraph d below.
(5) If the casualty’s chest
rises, proceed to feeling for pulse.
c. Apply chest thrusts. (Note that
the chest thrust technique is an alternate method that is used when the casualty
has an abdominal wound, when the casualty is so large that you cannot wrap your
arms around the abdomen, or when the casualty is pregnant.) To perform the chest
thrusts:
(1) Place the unconscious casualty on his back, face up, and open
his mouth. Kneel close to the side of the casualty’s body.
o Locate the lower
edge of the casualty’s ribs with your fingers. Run the fingers up along the rib
cage to the notch (Figure 2-23A).
o Place the middle finger on the notch and
the index finger next to the middle finger on the lower edge of the breastbone.
Place the heel of the other hand on the lower half of the breastbone next to the
two fingers (Figure 2-23B).
• Remove the fingers from the notch and place that
hand on top of the positioned hand on the breastbone, extending or interlocking
the fingers (Figure 2-23C).
• Straighten and lock your elbows with your shoulders
directly above your hands without bending the elbows, rocking, or allowing the
shoulders to sag. Apply enough pressure to depress the breastbone 1½ to
2 inches, then release the pressure completely (Figure 2-23D). Do this 6 to 10
times. Each thrust should be delivered slowly and distinctly. See Figure 2-24
for another view of the breastbone being depressed.
(2)
Repeat the sequence of chest thrust, finger sweep, and rescue breathing as long
as necessary to clear the object from the obstructed airway. See paragraph d
below.
(3) If the casualty’s chest rises, proceed to feeling for his pulse.
d.
Finger Sweep. If you still cannot administer rescue breathing due to an airway
obstruction, then remove the airway obstruction using the procedures in steps
(1) and (2) below.
(1) Place the casualty on his back, face up, turn the unconscious
casualty as a unit, and call out for help.
(2) Perform finger sweep, keep casualty
face up, use tongue-jaw lift to open mouth.
• Open the casualty’s mouth by
grasping both his tongue and lower jaw between your thumb and fingers and lifting
(tongue-jaw lift) (Figure 2-25). If you are unable to open his mouth, cross your
fingers and thumb (crossed-finger method) and push his teeth apart (Figure 2-26)
by pressing your thumb against his upper teeth and pressing your finger against
his lower teeth.
•
Insert the index finger of the other hand down along the inside of his cheek to
the base of the tongue. Use a hooking motion from the side of the mouth toward
the center to dislodge the foreign body (Figure 2-27).
 WARNING
Take
care not to force the object deeper into the airway by pushing it with the finger.
Continue
to Stop the Bleeding and Protect the Wound |
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