Page 36 - 2022 Ranger Medic Handbook

Airway Management
Airway management must be of prime concern for any trauma casualty. The setting, conditions, and injuries must be
taken into account for every casualty. In the tactical setting, hemorrhage control and shock resuscitation are more im-
portant than definitive airway management. Aggressive airway management is warranted in some casualties. However,
in many casualties, simple repositioning of an airway may solve airway, breathing, and oxygenation problems. Assess
every patient’s airway based on the setting, patient condition, and patient’s pending condition and take the appropriate
SECTION 2 predicted clinical course warrants a more aggressive action.
action. A patient who can breathe on his own should be allowed to breath on his own unless the injury pattern or
TCCC Application
Care Under Fire: Airway management, other than patient positioning, is generally best deferred until the Tactical Field
Care phase.
Tactical Field Care:
Unconscious casualty without airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin-lift or jaw-thrust maneuver
■ Nasopharyngeal airway
■ Place casualty in the recovery position
Casualty with airway obstruction or impending airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin-lift or jaw-thrust maneuver
■ Nasopharyngeal airway
■ Allow casualty to assume any position that best protects the airway, including sitting up
■ Place an unconscious casualty in the recovery position.
■ If previous measures are unsuccessful: surgical cricothyroidotomy (with pain control if conscious)
Tactical Evacuation: With every evacuation movement of a casualty, confirm airway placement and reassess airway
patency.
Unconscious casualty without airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin-lift or jaw-thrust maneuver
■ Nasopharyngeal airway
■ Place casualty in the recovery position
Casualty with airway obstruction or impending airway obstruction:
■ Inspect oropharynx and remove any foreign body from airway or lip. Do not conduct blind finger sweeps.
■ Chin-lift or jaw-thrust maneuver
■ Nasopharyngeal airway
■ Allow casualty to assume any position that best protects the airway, to include sitting up
■ Place unconscious casualty in the recovery position
■ If above measures are unsuccessful:
➣ Surgical cricothyroidotomy (with pain control if conscious)
➣ Supraglottic airway
Spinal immobilization is not necessary for casualties with penetrating trauma.
Extended Care
1. Monitoring: Maintain continuous pulse oximetry and EtCO 2 ; document serial vital signs.
2. Verify airway patency and with any evacuation or movement of the patient.
3. Suction: Consider periodic suctioning of the oropharynx and established airway tube.
4. Ventilation: The SAVe II Ventilator is a small, lightweight ventilator that automatically recommends ARDSnet lung protec-
tive settings based on the patient’s height. The default settings do not have PEEP and Medics must manually set the
vent to a PEEP of 5 at a minimum. The SAVe II does not require an external O 2 source, but supplemental O 2 can be
attached and set at no higher than 6L/m, which provides 62% oxygen. Any ventilator battery lasts for a limited amount
of time. For extended periods, consider alternating between a ventilator and BVM assisted ventilations with an attached
PEEP valve. Keep in mind that positive pressure ventilation is a known cause of tension pneumothorax.
5. Consider local wound care and further securing of cricothyroidotomy site if applicable.

22 SECTION 2 PRIMARY TRAUMA PROTOCOLS