jaw thrust

[rechargeable]

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?

 

[DisasterMedTech]

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?

 

[Flight-LP]

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

 

[RedZone]

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.

 

[rechargeable]

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?

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.

 

[reaper]

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:

 

[triemal04]

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...

 

[Ridryder911]

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

R/r 911

 

[rechargeable]

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.

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

R/r 911

 

[DisasterMedTech]

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?

 

[triemal04]

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.

 

[reaper]

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.

 

[DisasterMedTech]

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.

 

[triemal04]

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?

 

[Summit]

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

 

[reaper]

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.

 

[DisasterMedTech]

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.

 

[triemal04]

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.

 

[reaper]

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.

 

[skyemt]

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??