Premergency First Aid, CPR and AED Manual

2 PREmergency Scene Management

Airway in Responsive Patients A patient of any age who is talking or crying has an open airway. Look and listen to how the patient speaks for clues to the adequacy of their airway and their breathing. Normal breathing is quiet and requires little effort. Wheezing, gasping, or whistling noises as your patient breathes can indicate partial airway obstruction from swelling or a foreign object. A conscious patient that is unable to speak or moan (infant’s cry) most likely has a severe airway obstruction. If you identify an airway problem, stop the assessment, activate 911, and obtain a patent airway. This may be as simple as performing a “head-tilt/chin lift” to allow better air flow or more complex such as abdominal thrusts to remove a foreign object. Although airway and breathing problems are different, parts of the signs and symptoms are often shared. If the patient shows difficulty breathing or is not breathing, then begin treatment for Airway Management (Chapter 3).

Unresponsive Patients In an unresponsive patient or one with an altered mental state, the activation of 911 and determining an open airway must be done immediately. All unresponsive patients are assumed to have experienced trauma until proven otherwise. If there is any potential for trauma, then maintain the head in an in- line position and use the “Head Tilt Chin Lift” to open the airway, always protecting the spine. If you can confirm that no trauma affected the head and spine, then use the head tilt/chin lift method alone to obtain the airway. The Head Tilt Chin Lift described in the adjacent image is the standard of practice for opening an airway in an unresponsive patient. (See Chapter 3). The most common cause of airway obstruction in an unresponsive patient lying on their back is the patient’s own tongue.

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