8-2
possible to assess the airway. Be aware of C-Spine control and other possible injuries when moving patient.
Remember life has precedent over limb.
a. Look, listen and feel for respiratory effort.
(1) Look for bilateral rise and fall of the chest.
(2) Listen for air escaping during exhalation.
(3) Feel for breath exhaling from the casualty’s mouth on the side of your face.
b. If respiratory effort is detected, assess the respiratory effort for at least 6 seconds.
(1) Assess the quality of the respiratory effort as strong, moderate, or weak.
(2) Assess the rhythm of the respiratory effort as regular or irregular.
(3) Assess the rate of the respiratory effort: < 10 respirations per minute or >20 respirations per
minute are indicators for assisted ventilations.
NOTE: Multiply the number of respirations detected in a 6 second period x 10 to get the number
of respirations per minute.
c. If no respiratory effort is detected, check pulse.
(1) If the casualty is pulseless:
(a) In a combat situation, an unresponsive, non-breathing, pulseless casualty is a fatality. End
of this task.
(b) In a noncombat situation, initiate CPR (see Cardiac Resuscitation).
(2) If the casualty has a pulse, establish an airway immediately.
- Open and inspect the airway of an unconscious casualty.
a. Inspect head, face, and throat for signs of trauma and inhalation injuries. Signs of inhalation injuries
may include reddened face or singed eyebrows and nasal hair.
b. Open the airway using the appropriate technique.
(1) If working on a trauma casualty, use the jaw thrust technique:
(a) Kneel at the top of the casualty’s head.
(b) Grasp the angles of the casualty’s lower jaw.
(c) Rest your elbows on the surface on which the casualty is lying.
(d) Lift with both hands, displacing the lower jaw forward.
(2) If working on a non-trauma casualty, use the head-tilt/chin-lift method.
(a) Kneel at the level of the casualty’s shoulders.
(b) Place one hand on the casualty’s forehead and apply firm, backward pressure with the palm
of the hand to tilt the head back.
(c) Place the fingertips of the other hand under the bony part of the casualty’s lower jaw, bringing
the chin forward.
CAUTIONS: (1) Do not use the thumb to lift the lower jaw. (2) Do not press deeply into the soft tissue
under the chin with the fingers. (3) Do not completely close the casualty’s mouth.
c. Inspect the oral cavity for foreign material, blood, vomitus, avulsed teeth, and signs of inhalation
injuries. If the casualty has signs of trauma, foreign objects, and/or complications, continue with this
step.
(1) If casualty is breathing with adequate respiratory effort/air exchange and has no signs of trauma,
foreign objects, or complications of the upper airway, proceed to step 5.
(2) If airway is clear but no respiratory effort is detected, see step 6.
(3) If airway is not clear, regardless of respiratory effort, see step 7. - Insert an oropharyngeal airway (J tube) if the casualty is breathing, has no history of apnea, and no
trauma or complications of the upper airway. Have suction available before attempting.
a. The oropharyngeal airway should be approximately the same length as the distance from the corner
of the casualty’s mouth to tip of his ear lobe.
b. Insert the airway inverted until past the tongue and then rotate 180º.
WARNING: It is more traumatic (and contraindicated in children) to use this “corkscrew” technique. If
a tongue depressor is available, it is preferable to use it to depress the tongue and insert the oral airway
under direct vision.
c. Check for respiratory effort after J tube is inserted. Respiratory effort should be the same or improved
after insertion of J tube. If decreased, remove tube, re-inspect airway, reinsert J tube and reassess.
d. Have assistant provide ventilations and administer oxygen if available.