Page 130 - PJ MED OPS Handbook 8th Ed

7) Make an incision in the trachea.
8) Stabilize the trachea with non-dominant hand.
9) Make an incision between two rings of the trachea (between the 3rd and 4th or 4th
and 5th tracheal cartilages). Do NOT extend the incision more than one-half (50%)
of the diameter of the trachea. Do NOT incise at the cricothyroid ligament, as is
done in people.
10) Remove blood or mucus, if present.
11) Insert the tracheal retractor into the trachea.
12) Hook a lower tracheal ring and lift up so you can visualize the tracheal opening.
13) Insert tracheostomy tube (ideal) or endotracheal tube through the incision and di-
rect the distal opening down the trachea.
14) Use the largest tube that will fit in the trachea (7–11mm internal diameter tubes
are typical).
15) Immediately provide supplemental oxygen.
16) Breathe in the tube or use a hand-operated resuscitator.
17) Secure the tracheal tube by attaching gauze bandage to the tube and tying it around
the dog's neck in a bow knot. Inflate the cuff until you get back pressure.
18) If using a tracheostomy tube, secure the tracheostomy tube to the patient using um-
bilical tape, roll gauze, or similar material tied to the wings of the tube and passed
around the neck and tied with a quick release knot. Insert the inner cannula (if pro-
vided) in the tracheostomy tube (if used) and inflate the cuff of the tracheostomy
tube.
f. AIRWAY CONSIDERATIONS:
i) Size 9 or 10 mm cuffed endotracheal tube, secure with
gauze or IV tubing. Tie around ears.
ii) Passive flow airway – secure air line to muzzle.
iii) Field expedient masks.
iv) Dogs do not tolerate NPAs.
4. Respirations
a. Look, Listen, and Feel
b. If the dog is not breathing, compressions should be initiated
(100 per minute) immediately while a second person is se-
curing the airway.
c. Ventilate at 8–10 breaths per minute.
d. If available, use supplemental oxygen.
e. Needle thoracentesis: Place the dog in the lateral recumbent
position, go mid-way between sternum and spine between
the 7th and 9th ribs.
5. Circulation
a. Be sure that there are no major (pooling/spurting blood) points of bleeding. Control as
necessary.
b. Hemorrhagic Shock Fluid Resuscitation (Administration Routes):
i) Preferred is IV
ii) Secondary route is IO (humeral head or tibia)

NOTE: Sternal/manubrium IOs are contraindicated in K9s.

128 n Pararescue Medical Operations Handbook / 8th Edition