Airway & C-Spine

Question 1

Describe the anatomy of the C-Spine

Answer 1

The spinal column is made ip of 33 bones split as follows:

• 7 Cervical
• 12 Thoracic
• 5 Lumbar
• 5 Sacral (fused)
• 4 Coccygeal (fused)

The cervical spine is more flexible and less well protected than others parts of the spine, as a consequence it is at greater risk of injury. If cervical spine is injured then there is a possibility that the spinal cord is also injured, which may result in paralysis below the level of the injury. Damage is either complete or incomplete, the latter has the ability to recover but is prone to further injury if poorly managed.

Question 2

Describe manual stabilisation

Answer 2

• The safest position is supine
• C-spine in the neutral position
• Take control as soon as possible
• Don’t exert traction
• Don’t cover the ears

Question 3

What are the 3 steps to an airway assessment?

Answer 3

1. Check
2. Clear
3. Maintain

Question 4

Explain how to check an airway

Answer 4

• If conscious ask casualty to open mouth
• If unresponsive open mouth by pulling on lower jaw
  Consider other signs of obstructed airway:
• Cyanosis
• Choking
• Agitation
• Altered levels of consciousness
• Noisy Breathing

Question 5

What are the signs of a choking casualty?

Answer 5

• Collapse
• Cyanosis
• No obvious entry/chest movement
• No respiratory effort
• Respiratory arrest
• Anxiety/panic
• Coughing
• Clothing at the neck
• Red swollen face with swollen eyes
• Noisy respiratory effort

Question 6

Explain the treatment of a conscious casualty

Answer 6

• Calm casualty
• Inspect airway
• Lean casualty forward and encourage to cough
• Observe for expulsion of obstruction
• Backslaps
• Abdominal thrust

Question 7

Describe how to administer abdominal thrusts

Answer 7

• Clench your fist and place below the sternum above the umbilicus
• Grasp this hand with the other hand and pull sharply, upwards and inwards
• Repeat up to 5 times
• Ensure that pressure is not applied to the lower rib cage
• Deliver up to 5 Abdominal thrusts
• Repeat procedures until obstruction clears or patient becomes unconscious
• If patient becomes unconscious inspect the airway, if possible to remove obstruction do so using either suction or Magills forceps
• Commence chest compressions at a ratio of 30 compressions:2 ventilations
• Reassess the mouth quickly between each set of compressions

Question 8

Explain how to manage a unconscious choking casualty

Answer 8

• Check airway, try and remove the obstruction
• Open airway and assess breathing
• If patient is not breathing
• If no breathing then commence CPR and call 999
• 30 compressions at 5-6 cm depth and rate of 100-120 per minute
• 2 Ventilations using Pocket mask or Bag Valve mask
• Reassess after 2 minutes
• When extra resources arrive complete a handover using ATMIST

Question 9

Why is it important to check the airway?

Answer 9

• An unconscious casualty has no control over their muscles and the tongue will fall back across the airway
• The risk of airway obstrction is increased when lying flat on the back
• Material in the mouth such as food, blood and vomit may be present
• Remove all obstructions as soon as possible

Question 10

Explain airway procedure

Answer 10

• CHECK
• Stabilise – neutral alignment
• Open mouth
• Look
• Clear if needed- Suction – postural drainage

Question 11

What is postural drainage?

Answer 11

The need for postural drainage will depend on if the casualty has constant bleeding or vomiting in the mouth. Roll the casualty onto their side and open the mouth allowing all fluids to drain. Clearing can be assisted with the finger sweep technique.

Question 12

Describe the jaw thrust technique

Answer 12

• Locate angle of mandible
• Fingers under mandible, Palms on Zygoma
• Lift mandible upwards and forwards
• Using the thumbs open patients mouth

Question 13

Explain the recovery position

Answer 13

• During the primary survey the first priority is to open the airway to ensure the casualty can breathe or so the first aider can give rescue breaths.
• Where a casualty is breathing normally or their breathing returns during any stage of treatment and has a reduced level of response. The casualty should be placed into the recovery position. If there is no C-Spine consideration, and if there are no airway adjuncts available.

Question 14

Explain the airway adjunct - nasophyaryngeal airway (NPA)

Answer 14

• Sizing is size 6 for a female adult and size 7 for a male
• Lubricate prior to insertion usually in the right nostril as usually larger
• Ensure the passage of air
• Routinely reassess placement

Question 15

What can affect the insertion of an NPA?

Answer 15

• Severe nasal trauma
• Nasal polyps
• Bleeding Conditions
• Active Nosebleed

Question 16

Explain the airway Adjuncts- oropharyngeal Airway (OPA)

Answer 16

• Placed by the angle of the jaw to the mid incisor ( level with it) (demonstration)
• If patient rejects remove the adjunct
• Confirm passage of air
• Routinely confirm placement

Question 17

What can affect the insertion of a OPA?

Answer 17

• Trismus (lockjaw)
• Conscious casualty
• Severe facial trauma

Question 18

Explain the process of removing clothing

Answer 18

During your primary survey, when you get to Environment/Expose (CABCDE) you may have to sensitively loosen, open, cut away or remove clothing when necessary to examine the casualty.

• Always be sensitive to a casualties privacy and dignity
• Once an area has been exposed, recover it to maintain dignity
• Always ask them for permission before doing so

Only remove clothing to:

• Exposing an Injury
• Taking an accurate examination
• To provide treatment

When removing clothing try to minimise the disturbance to the casualty and where cutting is required cut along seams