Page 27 - JSOM Winter 2017

diameter, 6–7mm internal diameter, and 5-8cm of in- – Place an unconscious casualty in the recovery position.
tratracheal length (least desirable option) d. If the previous measures are unsuccessful, perform a sur-
– Use lidocaine if the casualty is conscious. gical cricothyroidotomy using one of the following:
d. Spinal stabilization is not necessary for casualties with – Cric-Key technique (preferred option)
penetrating trauma. – 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 in-
Tactical Evacuation Care
tratracheal length
3. Airway Management – Standard open surgical technique using a flanged and
a. Unconscious casualty without airway obstruction: cuffed airway cannula of less than 10mm outer diam-
– Chin lift or jaw thrust maneuver eter, 6–7mm internal diameter, and 5–8cm of intra-
– Nasopharyngeal airway tracheal length (least desirable option)
– Place casualty in the recovery position – Use lidocaine if the casualty is conscious.
b. Casualty with airway obstruction or impending airway e. Cervical spine stabilization is not necessary for casual-
obstruction: ties who have sustained only penetrating trauma.
– Chin lift or jaw thrust maneuver f. Monitor the hemoglobin oxygen saturation in casualties
– Nasopharyngeal airway to help assess airway patency.
– Allow casualty to assume any position that best pro- g. Always remember that the casualty’s airway status may
tects the airway, to include sitting up. change over time and requires frequent reassessment.
– Place unconscious casualty in the recovery position. *The i-gel is the preferred extraglottic airway because its gel-
c. If the previous measures are unsuccessful, assess the filled cuff makes it simpler to use and avoids the need for cuff
tactical and clinical situations, the equipment at hand, inflation and monitoring. If an extraglottic airway with an air-
and the skills and experience of the person provid- filled cuff is used, the cuff pressure must be monitored to avoid
ing care, and then select one of the following airway overpressurization, especially during TACEVAC on an aircraft
interventions: with the accompanying pressure changes.
– Supraglottic airway, or
– Endotracheal intubation or *Extraglottic airways will not be tolerated by a casualty who
– Perform a surgical cricothyroidotomy using one of is not deeply unconscious. If an unconscious casualty without
the following: direct airway trauma needs an airway intervention, but does
i. Cric-Key technique (Preferred option) not tolerate an extraglottic airway, consider the use of a naso-
ii. Bougie-aided open surgical technique using a pharyngeal airway.
flanged and cuffed airway cannula of less than *For casualties with trauma to the face and mouth, or facial
10mm outer diameter, 6–7mm internal diameter, burns with suspected inhalation injury, nasopharyngeal air-
and 5–8cm of intratracheal length ways and extraglottic airways may not suffice and a surgical
iii. Standard open surgical technique using a flanged cricothyroidotomy may be required.
and cuffed airway cannula of less than 10mm outer *Surgical cricothyroidotomies should not be performed on un-
diameter, 6–7mm internal diameter and 5–8cm of conscious casualties who have no direct airway trauma unless
intra-tracheal length (Least desirable option) use of a nasopharyngeal airway and/or an extraglottic airway
iv. Use lidocaine if the casualty is conscious. have been unsuccessful in opening the airway.
d. Spinal stabilization is not necessary for casualties with
penetrating trauma.
Tactical Evacuation Care
Proposed New Wording 3. Airway Management
*New wording in red text a. Conscious casualty with no airway problem identified:
*Preserved wording that has been relocated in blue text – No airway intervention required
b. Unconscious casualty without airway obstruction:
– Place casualty in the recovery position
Tactical Field Care
– Chin lift or jaw thrust maneuver or
4. Airway Management – Nasopharyngeal airway or
a. Conscious casualty with no airway problem identified: – Extraglottic airway
– No airway intervention required c. Casualty with airway obstruction or impending airway
b. Unconscious casualty without airway obstruction: obstruction:
– Place casualty in the recovery position – Allow a conscious casualty to assume any position
– Chin lift or jaw thrust maneuver or that best protects the airway, to include sitting up.
– Nasopharyngeal airway or – Use a chin lift or jaw thrust maneuver
– Extraglottic airway – Use suction if available and appropriate
c. Casualty with airway obstruction or impending airway – Nasopharyngeal airway or
obstruction: – Extraglottic airway (if the casualty is unconscious)
– Allow a conscious casualty to assume any position – Place an unconscious casualty in the recovery position.
that best protects the airway, to include sitting up. d. If the previous measures are unsuccessful, assess the
– Use a chin lift or jaw thrust maneuver tactical and clinical situations, the equipment at hand,
– Use suction if available and appropriate and the skills and experience of the person provid-
– Nasopharyngeal airway or ing care, and then select one of the following airway
– Extraglottic airway (if the casualty is unconscious) interventions:

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