We all have been taught the new CAB algorithm, however, remember in the austere environment there are a few times that A comes before B and C. Lightning strikes, avalanche burial and immersion hypothermia to name a few. But, we are here to talk about this diver. He bled to the point of unconsciousness and is no longer supporting his own airway. There are several things to consider regarding airway management.
First, c-spine precautions. I will develop a later blog to how to clear a c-spine in the austere environment, but, we will assume for this scenario that there is no indication of c-spine instability.
Next, we need to open the airway. I prefer the jaw thrust maneuver : see youtube clip @ https://www.youtube.com/watch?v=r3ckgEQEE_o This not only opens the airways, but will also provide a noxious stimuli that can break laryngospasm and stimulate breathing.
We must also consider tissue obstruction. An NPA or OPA could be placed in this patient to help with a patent airway. Delivery of air can be done via BVM or mouth to mouth. Remember, the body was designed to function on 21% O2, therefore, refer to my first blog on the importance of blood must go round and round. By quickly placing a tourniquet, we can decrease the need for supplemental O2. However, I am not saying that supplemental O2 is not needed, I am presenting a topic for thought on how all of these processes work together and why they are important in initial treatment. The airway can be secured with supra or sub glottic airways. Understand that only sub glottic airways are definitive airways via ETT or surgical cricothyrotomy. A supra glottic airway is a temporizing measuring and can be easily obstructed or dislodged. I will do an independent blog of surgical critics, as many have claimed to be experts, few are… many are scared to perform and you shouldn’t be, this is a very easy procedure, but muscle memory is essential. OK, I could go on for hours on this topic, but I think you get it, the airway has to be open, free and clear and air or 02 must be delivered. Don’t forget about suction and see my future blogs on field expedient suction devices. Also, don’t forget to secure that airway… safety pin, 550 cord, tape, ties, shoe strings or whatever you have available. Nothing worse than losing a perfectly placed airway.