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Basic Airway Management in an Unconscious Casualty.

In last weeks blog, we took a look at managing an unconscious casualty 
(https://www.redsquaremedical.com/unconsciousness-a-medical-emergency) and we mentioned the importance of managing their airway.

Airway management is at the start of the ABCs because it’s the most important. Quite simply, if you don’t have an open, (or patent) airway, anything else you do is pretty pointless. Knowing how to manage an airway really is the difference between life and death. 

Initial management is to open your unconscious casualty’s airway using a head tilt, chin lift, or a jaw thrust if you suspect a c-spine injury. If someone is unconscious, they can’t maintain their airway if they are on their back, so the recovery position is ideal if you don’t suspect a c-spine injury.

But what happens if your casualty doesn’t come round and you need to plan to manage their airway for a longer period of time.

There are lots of things to consider, but for the purpose of this video tutorial, we’re sticking to the equipment and techniques that are regulated for STCW, and that are M1905 compliant. This means you should have the equipment onboard, and have already been trained in these techniques, making this a really handy refresher!

First and foremost, you need to monitor the airway constantly. Check for any change in the skin colour. If they become grey or blue, particularly around the lips and fingertips (cyanosis), it could indicate that they aren’t getting enough oxygen.

Monitor their rate of breathing and whether their chest is moving equally on both sides. If their breathing becomes noisy, something has changed and you need to reassess.

Airway adjuncts are recommended for use to help manage airways (See p12 and p199 of the Ship Captain’s Medical Guide.) and you are likely to have two options onboard.

Oropharyngeal Airway (OPA).


OPAs are a mandatory part of your resuscitation kit and you have two sizes (3 and 4) available. They are small plastic tubes with a wider section at one end, the flange. An OPA can be used alone, or in conjunction with one (or two if needed) NPA. Once inserted, it prevents the tongue from slumping backwards and obstructing the airway. 


You can measure the right length and size by holding the flange level with incisors, next to the casualty’s face. The other end should reach the point of the jaw - imagine how it will sit when inserted. Alternatively, you can measure from the corner of the mouth to the corner of the ear lobe. 


To insert, turn it upside down and place inside the mouth, moving towards the back of the mouth, gently rotate and slide over the back of the tongue. Insert, Invert, Rotate, Locate!


This video shows how to size and insert an OPA: https://www.youtube.com/watch?v=Hzc_T4QBp4E

Nasopharyngeal Airway (NPA).


NPAs are an optional part of your resuscitation kit and both the 6mm and 7mm diameter NPAs are recommended. It’s simply a small rubbery tube with a wider section at one end, the flange. An NPA can be used alone, or in combination with an OPA, and can be really useful if the casualty is suffering from ‘trismus’, where the teeth clench and it’s impossible to use an OPA.


The right length and size is measured by holding one end at the side of the nostril; the other end should reach the ear lobe. Generally speaking, 6mm is suitable for women and 7mm for men. Interestingly, the right nostril is normally slightly bigger than the left, so most medics start there, but either side (or both if needed!) will do just fine. 


Lubricate the outside of the tube and insert it straight towards the back of the head, at a right angle to the face, not up towards the brain. It will naturally follow the curve of the airway. Trust us, it works! Once inserted, the flange will lie against the nostril.


The only caution is on the extremely rare occasion that a basal skull fracture is identified (by a wound, bruising around the eyes, bruising behind the ears, clear fluid coming out of the nose), an NPA should not be used.


This video shows how to insert an NPA: https://www.youtube.com/watch?v=gVgAlWRCZBs


We hope you’ve enjoyed this refresher and if you have any questions, please get in touch! Next week we’ll be sharing a drill that you can use onboard and practise airway management.


Go on admit it, this one is an absolute cracker that deserves to be shared...

by Rachel Smith 20 Mar, 2024
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