Airway + Breathing disorders, CPR notes
Lukas Dadak, MD
St. Ann's University Hospital, Brno
15740@mail.muni.cz

Basic Vital signs:
•RESPOND = consciousness
•A+B  breathing
•C circulation
Primary Survey = 20s

Recovery position
lseveral variations
lstable, near a true lateral position with the head dependent,
lwith no pressure on the chest to impair breathing
I: coma + spontaneous breathing
KI: back injury
KEY: check for breathing

lRemove the victim’s spectacles.
lKneel beside the victim and make sure that both legs are straight.
lPlace the arm nearest to you out at right angles to the body, elbow bent with the hand palm
uppermost
lBring the far arm across the chest, and hold the back of the hand against the victim’s cheek
nearest to you

lWith your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on
the ground.
lKeeping his hand pressed against his cheek, pull on the far leg to roll the victim towards you
onto his side.
lAdjust the upper leg so that both hip and knee are bent at right angles.
lTilt the head back to make sure the airway remains open.

Choking Conscious Adult
•uncommon but potentially treatable
•less than 1% of these incidents are fatal
When?    - witnessed
·while eating
·while playing (coins, toys)

Choking
Sings:
•clutch throat or mouth
•cough, gurgle, or vomiting noise, wheezing
•inability to speak or cry / great difficulty
•Breathing is labored.
•Anxiety
•turns blue (cyanosis) from lack of oxygen.
•if breathing is not restored, then becomes unconscious.

Inability to relieve the obstruction can cause:

•Breathing failure
•Brain damage
•Death

Narrowest place of airway:
Adult: glotis Child subglotic space


Foreign-Body Airway Obstruction
•relief FBAO = life saving procedure
•safe, effective, simple
•Cough and bend forwards
•5 Back blows/slaps
•5 Abdominal thrusts = (Heimlich Maneuver)
•Chest thrusts
•often you will need more than 1 procedure to clean airway

Mild obstruction
•Coughing generates high and sustained airway pressures and may expel the foreign body.
•Aggressive treatment, (back blows, abdominal thrusts, chest compression), may cause potentially
serious complications and could worsen the airway obstruction.
•Cntinuous observation until they
–improve
–severe airway obstruction may develop.

First aid:
155


Back blows
bend forwards
lStand to the side and slightly behind the victim.
lSupport the chest with one hand and lean
the victim well forwards so that when the
obstructing object is dislodged it comes out
of the mouth rather than goes further down
the airway.
lGive up to five sharp blows between the
shoulder blades with the heel of your other
hand

Heimlich man. = abdomen thrust
Increase pressure
under foreign body
•Stand behind the victim and put both arms round the upper part of his abdomen.
•Lean the victim forwards.
•Clench your fist and place it between the umbilicus and xiphisternum.
•Grasp this hand with your other hand and pull sharply inwards and upwards.
•Repeat up to five times

Chest thrust
•markedly obese persons
•late stages of pregnancy
Increase pressure
under foreign body

Following successful treatment:
Victims with a persistent cough, difficulty swallowing or the sensation of an object being still
stuck in the throat should be examined
lAbdominal thrusts can cause serious internal injuries
lall victims treated with abdominal thrusts should be examined for injury by a doctor

Clear airway if necessary
during coma
•with the casualty supported on the side,
tilt the head backwards and slightly down.
•Open the mouth and clear any foreign object.
Only remove dentures if loose or broken.
•Use your 2 fingers only - if you see solid material in the mouth
•Do not push fingers where you can not see

Keep airway open
haed tilt, chin lift Esmarch man.


Guedel airway
Oro-Pharyngeal Airway
I: unconsciousness
+ airway obstruction with tongue
Correct size OPA:
ldistance angle of mouth --- ear
Risk in mild unconsciousness:
lvomitus + aspiration

Naso-Pharyngeal Airway
(trumpet)
Correct size of NPA:
ldistance nostril --- ear
Risk:
lbleeding from nasal cavity
lUse of lubricant is essential

Face mask ventilation
Positive pressure ventilation by bag-valve mask
lcorrect volume = movement of chest
lf 10/min
l100% O2
l1 hand hold:
-inch + index f.
-3 ff. - chin
l2 hands