Page 17 - ATP-P 11th Ed

b. Unconscious casualty without airway obstruction:
i. Place casualty in the recovery position
ii. Chin lift or jaw thrust maneuver OR
iii. Nasopharyngeal airway OR SECTION 1
iv. Extraglotic airway
c. Casualty with airway obstruction or impending airway obstruction:
i. Allow a conscious casualty to assume any position that best protects the air-
way, to include sitting up and/or leaning forward.
ii. Use a chin lift or jaw thrust maneuver
iii. Use suction if available and appropriate
iv. Nasopharyngeal airway OR
v. Extraglottic airway (if the casualty is unconscious).
vi. Place an unconscious casualty in the recovery position.
vii. If the previous measures are unsuccessful, perform a surgical cricothyroidot-
omy using one of the following:
(a) Bougie-aided open surgical technique using a flanged and cuffed airway
cannula of less than 10mm outer diameter, 6–7mm internal diameter, and
5–8cm of intratracheal length.
(b) Standard open surgical technique using a flanged and cuffed airway can-
nula of less than 10mm outer diameter, 6–7mm internal diameter, and
5–8cm of intra-tracheal length.
(c) Use lidocaine if the casualty is conscious.
d. Cervical spine stabilization is not necessary for casualties who have sustained only
penetrating trauma.
e. Monitor the hemoglobin oxygen saturation in casualties to help assess airway
patency.
f. Always remember that the casualty’s airway status may change over time and re-
quires frequent reassessment.
Airway Notes:
a. If an extraglottic airway with an air-filled cuff is used, the cuff pressure must be
monitored to avoid overpressurization, especially during TACEVAC on an aircraft
with the accompanying pressure changes.
b. Extraglottic airways will not be tolerated by a casualty who is not deeply uncon-
scious. If an unconscious casualty without direct airway trauma needs an airway
intervention, but does not tolerate an extraglottic airway, consider the use of a naso-
pharyngeal airway.
c. For casualties with trauma to the face and mouth, or facial burns with suspected
inhalation injury, nasopharyngeal airways and extraglottic airways may not suffice
and a surgical cricothyroidotomy may be required.

6 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 7