TCCC_Respiration/Breathing

Question 1

What can we do for a casualty with airway obstruction or impending airway obstruction? (1-4)

Answer 1

1. Allow casualty to assume any position that protects the airway
2. Use a chin lift or jaw thrust maneuver
3. Nasopharyngeal airway
4. Use suction if available and appropriate

Question 2

What can we for a casualty with airway obstruction or impending airway obstruction? (5-7)

Answer 2

5. Extraglottic airway (if the casualty is unconscious)
6. Place an unconscious casualty in the recovery position.
7. if unsuccessful, surgical cric

Question 3

What are the major components for Respiration/Breathing assessment and control?

Answer 3

1. Assess and treat tension pneumothorax
2. Assess and treat sucking chest wounds
3. Initiate pulse oximetry [Readings may be misleading in shock or hypothermia]
4. Give o2 to keep sats > 94%.
5. ETco2 if available [monitor ventilation and perfusion]

Question 4

Suspect a tension pneumothorax and treat when a casualty has significant torso trauma or primary blast injury and one or more of the following: (1-3)

Answer 4

1. Severe or progressive respiratory distress
2. Severe or progressive tachypnea
3. Absent or markedly decreased breath sounds on one side of the chest

Question 5

Suspect a tension pneumothorax and treat when a casualty has significant torso trauma or primary blast injury and one or more of the following: (4-6)

Answer 5

4. saturation < 90% on pulse oximetry
5. Shock
6. Traumatic cardiac arrest without obviously fatal wounds

Question 6

Initial treatment of suspected tension pneumothorax:

Answer 6

1. If the casualty has a chest seal in place, burp or remove the chest seal.
2. Decompress the chest on the side of the injury with a 14-gauge 3.25-inch needle
3. If significant torso trauma or primary blast injury and is in traumatic cardiac arrest , decompress both sides of the chest

Question 7

Sites for needle decompression

Answer 7

1. Either the 5th intercostal space (ICS) in the anterior axillary line (AAL) or
2. the 2nd ICS in the mid-clavicular line (MCL) [If the anterior (MCL) site is used, do not insert the needle medial to the nipple line]

Question 8

Procedure for needle decompression

Answer 8

1. just over the top of the lower rib
2. Insert the needle/catheter unit all the way to the hub and hold it in place for 5-10 seconds to allow decompression to occur.
3. remove needle and leave catheter in place

Question 9

The NDC should be considered successful if:

Answer 9

1. Respiratory distress improves
2. obvious hissing sound (this may be difficult to appreciate in high-noise environments), or
3. saturation increases
4. vital signs improve
5. return of consciousness

Question 10

If the initial NDC fails to improve the casualty’s signs / symptoms from the suspected tension pneumothorax:

Answer 10

1. Perform a second NDC on the same side of the chest at whichever of the two recommended sites was not previously used.
2. Consider decompression of the opposite side of the chest

Question 11

If the initial NDC was successful, but symptoms later recur:

Answer 11

1. Perform another NDC at the same site that was used previously.
2. Continue to re-assess!

Question 12

What if open and/or sucking chest wound?

Answer 12

1. immediately apply a vented chest seal
2. If non, then non-vented chest seal
3. Monitor
4. Deteriorate, burp or removing the dressing
5. consider needle decompression