# jaw thrust



## rechargeable (Oct 13, 2007)

So, you read about the jaw thrust everywhere, and if I recall correctly, in my class I was told that if you perform the maneuver correctly, the jaw will remain in the elevated position without you having to hold it there.

For those of you who have actually successfully performed a jaw thrust, what does it feel like? Is there a click of some kind that you feel and then you let go and the jaw just stays there? I don't understand the mechanism of how the jaw remains elevated.

Naturally I mimic this on myself and can't imagine pushing on my jaw enough to make the mandible jam onto the rest of my skull. Is there a degree of implied trauma in the jaw thrust, like with CPR, or is it supposed something that doesn't cause damage?


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## DisasterMedTech (Oct 13, 2007)

Your comparison to the assumed damage done by CPR is a good one. With the modified jaw thrust, you are essentially dislocating the jaw, which is what it causes it to stay open and help to maintain a patent airway. There will be a discernible feeling and perhaps sound and the best way to describe it is that you  will know it when you hear/feel it. What I was taught is that while this sounds drastic and my cause some damage it beats the alternative which is losing your patient because you couldnt get an airway.  Make sense?


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## Flight-LP (Oct 13, 2007)

I have never dislocated anyones jaw while performing a jaw thrust. How are you performing it?????


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## RedZone (Oct 13, 2007)

I frequently use the jaw thrust and it works great.  THINKING about it creeps me out, but performing it is like 2nd nature, and it must be relatively painless because I've done it quite a few times on conscious patients (for instance, on a dementia person who put something in his mouth that shouldn't have been there) without even a complaint.

It WON'T work well on truly "CLENCHED" patients such as severe asthmatics... they need medication and advanced airway maneuvers.


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## rechargeable (Oct 13, 2007)

So RedZone, when you do it, do you feel a click or something that tells you when you've pulled hard enough? And the jaw stays in place after you've done it, even on the conscious patients, or do you have to sit there and hold it up?




RedZone said:


> I frequently use the jaw thrust and it works great.  THINKING about it creeps me out, but performing it is like 2nd nature, and it must be relatively painless because I've done it quite a few times on conscious patients (for instance, on a dementia person who put something in his mouth that shouldn't have been there) without even a complaint.
> 
> It WON'T work well on truly "CLENCHED" patients such as severe asthmatics... they need medication and advanced airway maneuvers.


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## reaper (Oct 13, 2007)

I'm with Flight, What are you being taught?

I have never dislocated a jaw. The jaw thrust is ment to be held that way by a second person. It does not stay open on it's own.

You should not be dislocating anyones jaw!!:sad:


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## triemal04 (Oct 13, 2007)

DisasterMedTech said:


> Your comparison to the assumed damage done by CPR is a good one. With the modified jaw thrust, you are essentially dislocating the jaw, which is what it causes it to stay open and help to maintain a patent airway. There will be a discernible feeling and perhaps sound and the best way to describe it is that you  will know it when you hear/feel it. What I was taught is that while this sounds drastic and my cause some damage it beats the alternative which is losing your patient because you couldnt get an airway.  Make sense?


No.  If you press hard enough to dislocate the jaw you have just done something wrong and created another problem to solve.  The jawthrust will not stay open on it's own; it's used when the head can't be tilted to due positioning/cervical compromise.  

I don't know why you'd say that, but I do know where I'd end up of I was routinely dislocating my pt's jaws when I used a jawthrust...


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## Ridryder911 (Oct 13, 2007)

Dislocate the jaw? Wow, that is a new technique I have never heard of! 

R/r 911


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## rechargeable (Oct 13, 2007)

I can see how someone might end up thinking that based upon the lack of detail that the book and literature goes into, and the implication that once the airway is opened that way that you can then go on to do other things. Though I assume once you put in an OPA that you can then let go.




Ridryder911 said:


> Dislocate the jaw? Wow, that is a new technique I have never heard of!
> 
> R/r 911


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## DisasterMedTech (Oct 13, 2007)

RedZone said:


> I frequently use the jaw thrust and it works great.  THINKING about it creeps me out, but performing it is like 2nd nature, and it must be relatively painless because I've done it quite a few times on conscious patients (for instance, on a dementia person who put something in his mouth that shouldn't have been there) without even a complaint.
> 
> It WON'T work well on truly "CLENCHED" patients such as severe asthmatics... they need medication and advanced airway maneuvers.



If youre using it frequently then more than one of us has run amuck. I was taught the technique by a 36 year veteran paramedic and 68whiskey Vietnam vet. It is not intended for common useage. I have used it twice thus far and what are you doing a modified jaw thrust for on a conscious patient? Someone is conscious and breathing you shouldnt be going anywhere near there jaw. If they have something in there mouth that they shouldnt have put there, using the jaw thrust is tantamount to using force to achieve a desired effect on a patient which is tantamount to battery. Im not sure what system your working in where you are forcing open the mouths of conscious patients, but I hope I never fall into the hands of any of its medics. Do you also kick them in the stomach if they wont give you their arm for an IV?


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## triemal04 (Oct 13, 2007)

DisasterMedTech said:


> If youre using it frequently then more than one of us has run amuck. I was taught the technique by a 36 year veteran paramedic and 68whiskey Vietnam vet. It is not intended for common useage. I have used it twice thus far and what are you doing a modified jaw thrust for on a conscious patient? Someone is conscious and breathing you shouldnt be going anywhere near there jaw. If they have something in there mouth that they shouldnt have put there, using the jaw thrust is tantamount to using force to achieve a desired effect on a patient which is tantamount to battery. Im not sure what system your working in where you are forcing open the mouths of conscious patients, but I hope I never fall into the hands of any of its medics. Do you also kick them in the stomach if they wont give you their arm for an IV?


And I hope I never end up being treated by someone who dislocates my jaw because they think that is how a jaw thrust is done.  Hate to tell you, it is a very common and basic technique that is taught at the EMT-Basic level.  What you are doing is not the jaw thrust, or modified jaw thrust.  Sorry.

And there is nothing at all wrong with using it frequently; personally I prefer to have my partner hold a jaw thrust instead of tilting the head in some situations.


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## reaper (Oct 13, 2007)

DisasterMedTech said:


> Your comparison to the assumed damage done by CPR is a good one. With the modified jaw thrust, you are essentially dislocating the jaw, which is what it causes it to stay open and help to maintain a patent airway. There will be a discernible feeling and perhaps sound and the best way to describe it is that you  will know it when you hear/feel it. What I was taught is that while this sounds drastic and my cause some damage it beats the alternative which is losing your patient because you couldnt get an airway.  Make sense?




No offense here, but you are ripping on someone about their techniques!

You are telling a student to dislocate a jaw. If you did this in my system, I would run you out of town.

A jaw thrust is not an a hard procedure and can be done on anyone that needs their airway opened. I have seen conscious pt's that cannot maintain their own airway. This procedure does not hurt a pt, if it is done right.

So you might want to rethink your decision.


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## DisasterMedTech (Oct 13, 2007)

Jaw thrust

"The jaw thrust is a technique used on patients with a suspected spinal injury and is used on a supine patient. The practitioner uses their thumbs to physically push the posterior (back) aspects of the mandible upwards - only possible on a patient with a GCS < 8 (although patients with a GCS higher than this should also be maintaining their own patent airway). When the mandible is *displaced* forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway.

ILCOR no longer advocates use of the jaw thrust by lay rescuers,[1] even for spinal-injured victims, although health care professionals still maintain the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims."
____________________________________________

Perhaps a literature reading update is in order. This was published in the Canadian edition of the Brady EMT text in 2006


And this from a French medical dictionary:

Jaw thrust maneuver

"The jaw thrust maneuver is a method of maintaining an open airway of an *unconscious* individual. Jaw thrust is used to open the mouth and lift the tongue which obstructs the patency of the airway. It is usually performed by placing on each side of the face, the index and middle fingers at the angle of the mandible. The thumbs are placed on the chin just below the lower lip. As the mouth is opened by exerting *downward force* on the chin, the index and middle fingers would lift the entire mandible anterior thus moving the base of the tongue out of obstruction."

The above Canadian reference was also published in cooperation with an obscure and little know medical outfit called the AMA.

The jaw thrust maneuver is indeed intended to displace the jaw. Of that there is no doubt. If you were not displacing the jaw, it would not work as it does. Not only is the method falling out of favor with lay responders, it is being phased out as arcane and un-necessary in the medical profession. In any case, you can see above why I was asking who would ever use it on a conscious patient? Unkindly, I will admit, but a patient with a GCS of <8 is generally considered as "gorked."  Hence the old medics addage "Less than 8, intubate."

If anyone is doing it often or "regularly" they are doing so un-necessarily and inappropriately. It certainly is not intended as a method to pry open a conscious patient's mouth simply because you want what they have in their mouth to be out of their mouth. If I saw you do it on a conscious patient, I would immediately order you out of service and back to a refresher course.


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## triemal04 (Oct 13, 2007)

Heehee.  This is fun.  Just so you know, displace does not equal dislocate.  So sorry.  What you were taught was not the jaw thrust.  Get over it.  

As for the excerts...that's just plain funny.  So, you've never found that doing something a bit differently than what is described in a book works great?  Or that the textbook version isn't always accurate?  Heh.  

Ahhh.  Again, it's a very routine movement that's pretty effective, and when done correctly does no damage to the pt.

Edit:  And if I saw you dislocate someone's jaw I'd be happy to do the same.  Gee, isn't this fun?
Double edit:  So what is your background anyway?  You're an EMT-B in some sort of "disaster responce group."  Can you elaborate a bit more an that?  Have you had any practical experience doing it?  Any practical field experience in EMS?  Is it a local neighborhood group, a state run, federally run group, what?


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## Summit (Oct 13, 2007)

So is this "dislocate the jaw" technique some story told to you by some hard core guy who was 5 hours into the wilderness with no airway adjuncts and no option but to leave his unconscious friend to get help? (and even then, I'd use a head-tilt before I'd try dislocating a jaw, something I'm not trained to do)

jaw thrust != jaw dislocation


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## reaper (Oct 13, 2007)

As said displace is not dislocate.

You do not do a headtilt on a cervical injured pt. This is where training and education comes in. 

 You may want to go to medic school and learn for yourself and not listen to everything the old medics tell you. Most of them will tell you to do a digital jaw pull!! Not me, no way.


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## DisasterMedTech (Oct 13, 2007)

The word and its synonym from the American Heritage Dictionary:
*
Verb	1.	displace - cause to move, usually with force or pressure; "the refugees were displaced by the war"
dislocate - put out of its usual place, position, or relationship*

And Im not quite sure with where my being a disaster medical technician comes in but for reference: I am a member of a an Illinois mass casualty event response team (Im not using its name because I believe that there was a cautionary placed on this forum about using unit names, etc, though I think I may have inadvertently done it anyway in a previous post). We respond at the state and federal level within 4 hours to natural disasters, terrorist events and search and rescue operations. To give you a frame of reference for that: the National Guard's standard time from call out to deploy is at least 72 hours and FEMA is greater than that as we have seen. We are trained and respond to CBRNE events at all levels and were intensely involved in the efforts after hurricane Katrina.

 And for the record, my opinions are my own. I do not speak for the organization with whom I am affiliated. I am not a public information officer. In any case, Im not talking about a CERT or MRC team here. While these are both valuable assets, they are not trained to respond at the level we are, nor do they possess the medical capabilities or technology that we do. And no, Im not saying its some covert operation or black ops or something. Im simply indicating that I think there was a "read this first" about using the names of organizations, military units, etc and I may have already used the name of the one of which I am a member, along with approximately 1,000 other people. It is the first team of its kind in the country and has served as the training model for other state teams and DMATS. You can find us by a simple google search.

So, how was your day?

We can argue til the cows come home, the fact is that the jaw thrust is to be used on an unconscious patient and even then it is not intended for every person we treat. Like the "displacing" of sterno-costal cartilage with CPR, the displacement and possible damage to tissue such as tendons and muscles of the jaw is an understood possibility with the jaw thrust.


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## triemal04 (Oct 13, 2007)

I only asked because it makes sense that if you were improperly trained and have little practical field experience and exposure to the proper use of the jawthrust it's not suprising that you have this opinion.  No biggie.  Just remember that the jawthrust, when used as intended does not dislocate the jaw, it temporarily moves it anteriorly.  When pressure is released the jaw falls back into place.  And with no resistance the chance of doing tissue damage is very minimal.  It is no longer recommended for untrained personell because they very well could do what you were advocating and dislocate the jaw, due to improper training, exitement, whatever.  And while not needed on every unconscious pt, it is a very usefull and routine procedure for opening an airway.


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## reaper (Oct 13, 2007)

I'm not trying to argue with you.

I just don't want a student thinking that they have to dislocate the jaw in a jaw thrust.

I have been using it for 17 yrs and have never dislocated or injured a pt using it. I am happy that you are using your skills to help others. I have served at disasters all over the globe. I lived and worked thru Andrew, long before the disaster teams showed up.
No one is dogging you for your job. People are trying to keep correct info on the site. Students come here looking for answers and want the correct info.
That is why the site is here, to help.


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## skyemt (Oct 13, 2007)

also, rechargeable, an opa is an airway adjunct, which helps keep the tongue from blocking the airway, but IT DOES NOT MAKE FOR A SECURE AND PATENT AIRWAY... so,no, you can't just put one in and go on to do other things...

and all this talk about dislocating jaws?  what happened to DO NO HARM?

WOW!  well, triemal04, for all of us involved in the debate about whether or not current education is sufficient, this thread pretty much puts that to bed, don't you think??


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## reaper (Oct 13, 2007)

Ahh, come on Sky, I thought the were just creating new ways to do things!!


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## rechargeable (Oct 14, 2007)

Okay, so despite all this, I still don't seem to have an answer. 

What does a correctly executed jaw thrust feel like (if anything beyond seeing/hearing/feeling an open airway), and once done, does it stay open on its own? So far I'm gathering that it doesn't feel like much of anything other than seeing the jaw DISPLACE and witnessing an open airway, and that it does not stay open on its own. This implies that an additional EMT is then needed just to maintain the jaw thrust. Is that correct?

I agree entirely about your statement about education. The books leave many questions unanswered, and I feel like every time I've ever wanted something clarified in learning about EMS, I get no answer and initiate a thread or conversation exactly like this one. 




skyemt said:


> also, rechargeable, an opa is an airway adjunct, which helps keep the tongue from blocking the airway, but IT DOES NOT MAKE FOR A SECURE AND PATENT AIRWAY... so,no, you can't just put one in and go on to do other things...
> 
> and all this talk about dislocating jaws?  what happened to DO NO HARM?
> 
> WOW!  well, triemal04, for all of us involved in the debate about whether or not current education is sufficient, this thread pretty much puts that to bed, don't you think??


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## RedZone (Oct 14, 2007)

rechargeable said:


> Okay, so despite all this, I still don't seem to have an answer.
> 
> What does a correctly executed jaw thrust feel like (if anything beyond seeing/hearing/feeling an open airway), and once done, does it stay open on its own? So far I'm gathering that it doesn't feel like much of anything other than seeing the jaw DISPLACE and witnessing an open airway, and that it does not stay open on its own. This implies that an additional EMT is then needed just to maintain the jaw thrust. Is that correct?
> 
> I agree entirely about your statement about education. The books leave many questions unanswered, and I feel like every time I've ever wanted something clarified in learning about EMS, I get no answer and initiate a thread or conversation exactly like this one.




Good question.  It actually feels pretty natural.  No clicking, snapping, or anything like that.  I can't think of anybody where the jaw stayed open by itself.  As far as needing a 2nd EMT to maintain the thrust.... for what purpose would you want to maintain it?  Just because someone's mouth is closed doesn't equate to an obstructed airway.  Insert an OPA if necessary, and monitor the airway and in most cases you'll be fine.  

If you have to keep the airway open because of serious airway compromise (maybe profuse bleeding from the airway??) then you may have an indication for ALS to do advanced maneuvers if time permits.

As far as the little war that erupted here... I'll just correct two things.  I don't do it OFTEN, but I've done it many times.  I've worked 13 years in a high volume system.  Conscious patients, I've only done it a FEW times (as opposed to quite a few).  

Moving on.  If a dementia patient, let's say, grabs a foreign object and places it in his mouth.... as long as I feel that there is a moderate risk to his life if I don't take action and he is incapable of providing consent... I have implied consent.  To wait for him to choke instead of removing the object... well... that's incompetence.  This case, I simply announced to the nurse (we were already at the hospital) that I was holding a jaw thrust so she could remove the object.  The patient was in NO distress whatsoever, but couldn't operate his jaw to close his mouth until I released it.  And no, he wasn't left lying in bed like some drooling infant with his jaw swinging around.  I let go, and everything went back in place.

Also, as someone pointed out, GCS < 8 is the accepted standard for automatic intubation in a TRAUMA patient only.  I believe this is the standard put in place by the American Academy of Trauma Surgeons.  GCS < 8 in a trauma probably means the patient is going to be in an OR anyway, so intubation is just routine.  Just to point out though, GCS < 8 doesn't necessarily mean unconscious.


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## reaper (Oct 14, 2007)

Red, has a very good point. GCS<8 does not me anything, except in trauma pt's. You can have a dementia pt that has a GCS <8, but doesn't need to be intubated.
But, a dementia pt is not competent to make medical decisions for them selves. So yes, you will do what you feel needs to be done.

A jaw thrust is mainly done in trauma pt's, that cannot have a headtilt-chinlift preformed on them. To help keep airway open. I don't know where the foreign object placed in the mouth came from? A jaw thrust is used to lift the tongue out of the way. This is the biggest obstruction you run into.

A jaw thrust can be held by one person, while bagging. If, you have large enough hands to do it. Some women don't, so you need a second person to hold it while you bag them.

This is something you should be showed and practice in class, so you understand how it is done.


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## RedZone (Oct 14, 2007)

reaper said:


> Red, has a very good point. GCS<8 does not me anything, except in trauma pt's. You can have a dementia pt that has a GCS <8, but doesn't need to be intubated.
> But, a dementia pt is not competent to make medical decisions for them selves. So yes, you will do what you feel needs to be done.
> 
> A jaw thrust is mainly done in trauma pt's, that cannot have a headtilt-chinlift preformed on them. To help keep airway open. I don't know where the foreign object placed in the mouth came from? A jaw thrust is used to lift the tongue out of the way. This is the biggest obstruction you run into.
> ...





If I remember right, he grabbed something from the nurse's hands or her pocket and just popped it in his mouth and closed it.  It was like an automatic reaction... the first thing I thought of was to jaw thrust (head-tilt chin lift wouldn't have opened his mouth to get at the object, and I'm not shoving my fingers in his mouth if he can bite me).  It turned out to be quite effective, and was probably the most humane way to remove the object as opposed to the "barbaric" picture one person is trying to portray.  

Improv is probably 65% or more of EMS work.


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## Ridryder911 (Oct 14, 2007)

Wow! To make something so simple .. dramatic. MJT is a very simple technique that was taught to common laymen, until the past few years ago. It does not have to be taught by a rescue ranger, nor is a difficult technique. 
Something, I still use over and over .. 

The main point is the patient muscles has to be relaxed enough to for it to be able to be performed. There is no clicking, special feeling, really nothing to brag about. Your simply moving the relaxed jaw. Their is no magic number in the Glasgow, nor does it have be trauma induced etc.. I use it all the time on patients that has Kyphosis (arthritic fused neck), Grannies that fall in a tub, or with an AMI that has major osteoarthritic history. Practice it on a mannequin (yes, it can be performed on a CPR mannequin) until proficient, then when it you need to perform it, you will be able to. 

There is only two patent airways... the normal responsive patient and those that have been ETI. The other(s) are airway adjuncts.. yes, they can *assist* in maintaining an airway. It is not that difficult.. head tilt (in non-trauma) with an OPA, or NPA is usually sufficient to open the airway, but not to maintain.. without risks of aspiration from vomiting.. etc. 

For as removing an object from someones mouth... I guess they no longer teach cross finger technique, where no one can "bite" down. 

The other thing is "So what?" They chances are they going to swallow it.. if it is non-digestible, it will come out in the end (pun intended) Kids, make change all the time... If they attempt to aspirate (which is unlikely, if they are awake they will have a "gag reflex"), either they will cough, or they will aspirate it into the lungs.. again, they can retrieve it per bronchoscope..

Again, it is a routine event.. 

R/r 911


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## Flight-LP (Oct 14, 2007)

DisasterMedTech said:


> Jaw thrust
> 
> "The jaw thrust is a technique used on patients with a suspected spinal injury and is used on a supine patient. The practitioner uses their thumbs to physically push the posterior (back) aspects of the mandible upwards - only possible on a patient with a GCS < 8 (although patients with a GCS higher than this should also be maintaining their own patent airway). When the mandible is *displaced* forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway.
> 
> ...



Allright, I've about had it with you......................

Listen and listen good. Just 6 days ago you are asking us how to blouse your boots and now you are some freakin expert on anything and everything. First off, the jaw thrust is indicated if needed on all pts. conscious or unconscious. 2nd off, it was not designed nor is it appropriate to dislocate someones jaw. Your 'Nam vet friend showed you a technique that was utilized by the military in much different circumstances. 3rd off, perhaps if you took a moment to LISTEN to others, you may actually learn something. Thus far you have argued with several VETERAN medics, VETERAN military operatives, and VETERAN police officers. For an EMT-B to come into our forum and start vomiting diarrhea from the mouth is completely innappropriate and establishes ZERO credibility on your part. Especially when YOU ARE WRONG!

So here's some free advice............

Sit back, enjoy the forum and listen to what others have to say. You may surprised, some of us know what we are talking about.............

And one last thing. Don't pull the Katrina card. Your DMAT team was nothing special down there. IT was just one of MANY organizations that grouped together for a cause. 

Pride is one thing, but not to be confused with egotism. Since your good at pulling up definitions, you can get my drift...................

Now your squared away! 



























Off to my time-out corner before FF8978 drags me there............................

I hope everyone has a wonderful evening.


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## Ridryder911 (Oct 14, 2007)

Atta boy!.. now, breathe deeply and inhale the Xanax spray... 

I have to agree from one that has been a member of DMAT for the past 15 yrs.. It is a good organization, that anyone that is medical can participate and join in. . 

R/r 911


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## rgnoon (Oct 14, 2007)

Remind me not to find myself with a compromised airway in Illinois. 

On a separate note, (I think/hope) We all know that the MJT is not meant to dislocate the jaw, but frankly I'd be concerned about the dislocated jaw further obstructing the airway.

Now how about passing that xanax...its not nice not to share :-D


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## ffemt8978 (Oct 14, 2007)

Flight-LP said:


> Off to my time-out corner before FF8978 drags me there............................
> 
> I hope everyone has a wonderful evening.



No need for me to do that if you're already there.


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## jrm818 (Oct 14, 2007)

Just in case there's any doubt remaining about what a modified jaw thrust is...

heres a movie of a guy doing it to another completely concious, uninjured guy.  There is no trauma as a result of the jaw thrust.  The joint of the jaw is not dislocated....rather the jaw is moved ("displaced").  American Heritage is a bad source for medical definitions anywyas.

P.S.  it's the first hit on google for "jaw thrust"


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## Gbro (Oct 14, 2007)

When I was just getting started in 1980, The EMT's on my service talked about dislocating the jaw in a cervical spine injury. 
Then came the EOA,  
http://www.med-worldwide.com/product1607.html

This airway has been on the rig ever since.

Remember back in those day we were taught some very impractical techniques.
Like Cervical traction! 18Lbs of traction that wasn't to be let up on until the Multi Trauma dressing/Kling was in place. Then when one would ask for a swap, they new guy would have to overtake the others traction. Whew, am i glad i never got a neck ache in those days.


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## DisasterMedTech (Oct 17, 2007)

If ya'll will read my most recent posting in the stair chair thread...I think it might help understand where Im coming from.  THanks.


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## hippopotassium (Oct 19, 2007)

Hey, 

While we're on the subject of jaw thrusts, can you use an OPA when you've done a jaw thrust? I can't imagine why not, but one of the TAs in my class (I'm a student) said that you couldn't.


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## Gbro (Oct 19, 2007)

As the OPA keeps the airway open, I say yes. Be careful to keep it in the proper location.


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