8-1
PART 8: PROCEDURES
Chapter 33 Basic Medical Skills
Procedure: Airway Management
18D Skills and Training Manual, Adapted by COL Warren Whitlock, MC, USAWhat: How to assess and control the patient’s airway. This guideline does NOT address an entire trauma
assessment.
When: You have a casualty in respiratory distress. Airway: Check for airway patency. Open the casualty’s
airway and establish the least invasive but most effective airway. Breathing: Determine if the casualty is
exchanging air sufficiently to maintain oxygen saturation, or requires assisted ventilations. Monitor: After
checking and correcting the airway and breathing status, monitor to insure no deterioration. Perform these
procedures without causing further injury to the patient.
What You Need: Various sizes of nasal and oropharyngeal airways (see below), gloves, gauze pads,
tongue blades, bag-valve-mask (BVM) system, water-soluble lubricant, 10cc syringe to inflate the cuff,
stylette, laryngoscope with blades, endotracheal tubes (rough size of little finger diameter; 7-9 for adult, 6-7
for adolescents, 4-6 for children [uncuffed], 3.5-4 for infants [uncuffed]), and oxygen/suction (if available),
and emergency drugs.
What To Do:
- Assess consciousness: does casualty respond to shake and shout, or painful stimuli?
a. If patient is conscious, go to step 2.
b. If patient is unconscious, go to step 3. - Assess airway and respirations in a conscious casualty.
NOTE: Assessing the airway and respirations are two different steps in the trauma sequence, but every time
the airway is assessed, the respiratory effort can also be partially assessed. However, a clear airway with
respiratory effort detected does not fully clear the respiratory system. After assessing the airway, assess
respiratory effort bilaterally to ensure that both lungs are working and air movement is adequate.
a. Ask casualty simple questions to determine status of airway.
(1) If casualty can talk to you without difficulty, airway is clear.
(2) If the patient answers with difficulty, coughing, pain, hoarseness or other difficulty, manage the
airway using the same procedure as if the casualty were unconscious (Step 3).
b. Auscultate both lungs to ensure that air is being exchanged equally bilaterally.
c. If history does not point to respiratory/airway involvement and there are no signs of respiratory
distress present, continue primary assessment.
(1) Monitor the patient’s airway and respirations.
(2) Monitor for signs and symptoms of hypoxia.
d. If signs of respiratory distress develop:
(1) Initiate appropriate treatment immediately.
NOTE: Do not attempt to insert oropharyngeal airways or endotracheal tubes in conscious casualties
unless they have a history or signs of inhalation burns/injuries.
(2) Give supplemental oxygen, if available.
NOTE: Failure to notice signs and symptoms of hypoxia or respiratory distress early may have
catastrophic effect on the patient.
e. If casualty becomes unconscious, manage casualty IAW step 3. - Assess airway and respirations in an unconscious casualty.
NOTE: If patient is in a position that makes assessing the airway impossible, move the patient as little as