Page 268 - PJ MED OPS Handbook 8th Ed

iii) Nasopharyngeal airway OR
iv) Extraglottic airway
c. Casualty with airway obstruction or impending airway obstruction:
i) Allow a conscious casualty to assume any position that best protects the airway, 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
d. If the previous measures are unsuccessful, perform a surgical cricothyroidotomy using one of
the following:
i) Cric-Key technique
ii) 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
iii) Standard open surgical technique using a flanged and cuffed airway cannula of less than
10mm outer diameter, 6–7mm internal diameter, and 5–8cm of intra-tracheal length
(least desirable option)
iv) Use local anesthetic and Procedural Sedation Protocol if the casualty is conscious and
clinical and tactical situation permit

NOTE: Localize the airway in a thick neck patient by using a syringe with needle to aspirate
air, leave needle in place, make incision on needle, and place bougie or use tracheal hook for
positive control of the airway.

e. Cervical spine stabilization is not necessary for casualties who have sustained only penetrat-
ing trauma. Perform spinal motion restriction if unable to clear the spine (A and O, no drugs/
ETOH/pain meds, no midline spine pain or tenderness, neuro intact, no pain with motion).
f. Monitor the hemoglobin oxygen saturation in casualties may change over time and requires
frequent reassessment.
g. Always remember that the casualty’s airway status may change over time and requires fre-
quent reassessment.

NOTES:
• 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 accompany-
ing pressure changes.
• Extraglottic airways will not be tolerated by a casualty who is not deeply unconscious. If an
unconscious casualty without direct airway trauma needs an airway intervention, but does
not tolerate an extraglottic airway, consider the use of a nasopharyngeal airway.
• 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 cri-
cothyroidotomy may be required.
• Surgical cricothyroidotomies should not be performed on unconscious casualties who have
no direct airway trauma unless use of a nasopharyngeal airway and/or an extraglottic air-
way have been unsuccessful in opening the airway.

266 n Pararescue Medical Operations Handbook / 8th Edition