Page 56 - JSOM Winter 2024

– (1) Bougie-aided open surgical technique using a curved Disclaimers
shaped, flanged and cuffed airway cannula of less than The opinions or assertions contained herein are the private
10mm outer diameter, 6–7mm internal diameter, and views of the authors and are not to be construed as official or
5–8cm of intra-tracheal length (Preferred option) -or- as reflecting the views of the Department of the Department
– (2) Standard open surgical technique using a curved of Defense. The recommendations contained in this paper are
shaped, flanged and cuffed airway cannula of less than intended to be guidelines only and are not a substitute for clin-
10mm outer diameter, 6–7 mm internal diameter, and ical judgment.
5–8cm of intratracheal length
– Verify placement by EtCO digital capnography Disclosures
2
– Use lidocaine if the casualty is conscious. The authors have no disclosures.
– Frequently reassess SpO , EtCO and airway patency as
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airway status may change over time. Release
This document was reviewed by the Director of the Joint
Tactical Field Care (Respiration/Breathing) Trauma System and by the Public Affairs Office and the Op-
(Add to bottom of section) erational Security Office at the Defense Health Agency. It is
• If the patient has impaired ventilation and uncorrectable approved for unlimited public release.
hypoxia with a desaturating SpO below 90%, consider
2
insertion of a properly sized nasopharyngeal airway, and References
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• Use EtCO and SpO monitoring to help assess airway care in special operations. Mil Med. 1996;161 Suppl:3-16. doi:
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Acknowledgments 15. Izumi C, Iga K, Himura Y, Gen H, Konishi T. Influence of gravity
The authors gratefully acknowledge the research assistance on pulmonary venous flow velocity patterns: analysis of left and
provided by Danielle Davis of the Joint Trauma System. The right pulmonary venous flow velocities in left and right decubi-
tus positions. Am Heart J. 1999;137(3):419–426. doi:10.1016/
authors also thank the Department of Defense Trauma Reg- S0002-8703(99)70486-2
istry for providing the combat casualty data discussed in this 16. Tanabe K, Yoshitomi H, Oyake N, et al. Effects of supine and
report. lateral recumbent positions on pulmonary venous flow in healthy
54 | JSOM Volume 24, Edition 4 / Winter 2024