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e. Continue with the survey.
- If the casualty has no respiratory effort and no apparent obstruction of the airway, attempt to
give 2 breaths using the rescue breathing technique.
a. If the breaths go in, intubate and ventilate the casualty (see Procedure: Intubate a Patient).
b. If the breaths do not go in, attempt to reopen the airway again and give 2 more breaths.
(1) If the breaths go in, intubate and ventilate the casualty.
(2) If breaths still do not go in, insert laryngoscope and inspect the oropharynx for foreign body, blood,
vomitus, swelling or other causes of obstruction.
(3) Using forceps, attempt to remove any foreign objects seen.
(a) If able to clear airway, attempt 2 breaths and assess for return of spontaneous respirations.
NOTE: If at any time spontaneous respirations return after clearing an airway, the casualty requires
assisted ventilations with an oropharyngeal airway or ET tube. Casualties who were apnic for any
length of time will have an elevated CO 2 level. Traumatized casualties who were apneic will have
difficulty regaining O 2 saturation. They may start off breathing adequately, but their CO 2 deficit
will cause them to destabilize over time. Failure to assist ventilations in a formerly apneic casualty
WILL cause harm and possible death.
(b) If unable to clear airway, perform surgical cricothyroidotomy (see Procedure:
Cricothyroidotomy).
(c) If the situation makes it impossible to perform an immediate surgical cricothyroidotomy,
perform a needle cricothyroidotomy (see Procedure: Cricothyroidotomy).
(4) If no obstruction is seen but vocal cords are visualized, attempt to intubate casualty
(a) Successful intubation: ventilate casualty (see Procedure: Intubation).
(b) Unsuccessful intubation: perform surgical or needle cricothyroidotomy (see Procedure:
Cricothyroidotomy).
(5) If no obstruction of airway is seen but vocal cords are not visualized, perform surgical
cricothyroidotomy. - Clear the airway of a casualty who may or may not be breathing.
a. Clear any foreign material or vomitus from the mouth as quickly as possible using forceps or the
finger sweep method.
b. If casualty is vomiting, turn head to the side or roll casualty on side to prevent aspiration.
CAUTION: Be aware of C-spine and other injuries.
c. Stem bleeding into the oral cavity with packed gauze, but only after a secure airway is in place.
d. After clearing the obstruction, assess the respirations and determine the type of airway required based
on the cause of the obstruction and the situation.
NOTE: Casualties who are vomiting or bleeding into their naso-oropharynx need a secured airway, i.e., ET
tube, to protect against aspiration. In a combat situation, the medic may have to settle for a J tube until
time and circumstances permit him to intubate the casualty.
(1) If the casualty is breathing on his own with little or no chance of aspiration, insert J tube.
(2) If the casualty is not breathing or has minimal respiratory effort, or there is a chance for aspiration,
intubation is preferred.
e. Secure airway with an oropharyngeal airway or an ET tube.
f. If blockage cannot be removed or injuries make obtaining a secure oral airway improbable, give
casualty a cricothyroidotomy immediately (see Procedure: Cricothyroidotomy).
g. Assist ventilations with Bag-valve Mask and oxygen if available. - Monitor airway and respiratory effort for at least q 5 min while you continue the primary survey.
a. After Primary Survey is complete, reassess casualty’s LOC, airway, and respiratory status to
determine if additional management is required to further control and protect the airway.
b. Unconscious casualties require intubation to further control and protect airway (see Procedure:
Intubation)
c. If the casualty is in severe respiratory distress or arrest and cannot be intubated, you must perform a
cricothyroidotomy (see Procedure: Cricothyroidotomy) - Monitor and assess casualty on regular basis to determine if ABCs are improving or worsening.
- Adjust treatment to compensate for improving or worsening status of the casualty.
- Evacuate casualty to nearest appropriate medical treatment facility.