Page 29 - 2021 Advanced Ranger First Responder Handbook

Airway Management
Airway management must be of prime concern for any trauma casualty. The setting, conditions, and injuries must be
taken into account for every casualty. In the tactical setting, hemorrhage control and shock resuscitation are more im-
portant than definitive airway management. Aggressive airway management is warranted in some casualties. However,
in many casualties, simple repositioning of an airway may solve airway, breathing and oxygenation problems. Assess
every patient’s airway based on the setting, patient condition, and patient’s pending condition, and take the appropriate
action. A patient who can breathe on his own should be allowed to breath on his own unless the injury pattern or
predicted clinical course warrants a more aggressive action.
TCCC Application
Care Under Fire: Airway management, other than patient positioning, is generally best deferred until the tactical field
care phase.
Tactical Field Care:
Unconscious casualty without airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin lift or jaw thrust maneuver
■ Nasopharyngeal airway
■ Place casualty in the recovery position.
Casualty with airway obstruction or impending airway obstruction: A
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin lift or jaw thrust maneuver
■ Nasopharyngeal airway
■ Allow casualty to assume any position that best protects the airway, including sitting up.
■ Place an unconscious casualty in the recovery position.
■ If previous measures are unsuccessful: PLACE SUPRAGLOTTIC AIRWAY and SEEK HIGHER LEVEL MEDICAL
CARE.
Tactical Evacuation: With every evacuation movement of a casualty, confirm airway placement and reassess airway
patency.
Unconscious casualty without airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin lift or jaw thrust maneuver
■ Nasopharyngeal airway
■ Place casualty in the recovery position.
Casualty with airway obstruction or impending airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin lift or jaw thrust maneuver
■ Nasopharyngeal airway
■ Allow casualty to assume any position that best protects the airway, including sitting up.
■ Place unconscious casualty in the recovery position.
■ If above measures are unsuccessful:
➣ Supraglottic Airway
Spinal immobilization is not necessary for casualties with isolated penetrating trauma.
Extended Care
1. Monitoring: Maintain continuous pulse oximetry and EtCO 2 ; document serial vital signs.
2. Verify airway patency, and with any evacuation or movement of the patient.
3. Suction: Consider periodic suctioning of the oropharynx and established airway tube.
4. Ventilation: The SAVe II Ventilator is a small, lightweight ventilator that automatically recommends lung protective
settings based on the patient’s height. The default settings do not have positive end-expiratory pressure (PEEP) and
medics must manually set the vent to a PEEP of 5 at a minimum. The SAVe II does not require an external O 2 source,
but supplemental O 2 can be attached and set at no higher than 6L/min, which provides 62% O 2 . Any ventilator bat-
tery lasts for a limited amount of time. For extended periods, consider alternating between a ventilator and bag-valve
mask (BVM)-assisted ventilations with an attached PEEP valve. Keep in mind that positive pressure ventilation
(from BVM or ventilator use) is a known cause of tension pneumothorax.
5. Consider local wound care and further securing of cricothyroidotomy site if applicable.

2021 ADVANCED RANGER FIRST RESPONDER HANDBOOK 19