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Obstructed Airway Question

Discussion in 'Scenarios' started by Mike97, Apr 10, 2018.

  1. Mike97

    Mike97 Forum Ride Along

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    Student here. I’ve got a question on a patient with an obstructed airway that is unconscious.

    The books say if the patient goes unconscious to give chest compressions. But, what if they are not pulseless? Would you start compressions regardless as an attempt to clear the obstruction?
     
  2. cprted

    cprted Forum Captain

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    Without a patent airway, the patient will become pulseless in fairly short order. An airway emergency tops pretty much everything else, thus chest compressions are indicated. In this situation, the compressions are about attempting to dislodge the obstruction, not CPR.

    That being said, check to see if the obstruction dislodged when they became unresponsive.
     
    bigbaldguy and Mike97 like this.
  3. MedicMcGoo

    MedicMcGoo Forum Ride Along

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    Also according to the University of Arizona there is slim to no chance of injuring a patient when performing chest compressions on a beating heart.

    The real goal is to get that foreign body up and out of the airway or down and into the lung to get at least half of the lungs to ventilate.
     
    bigbaldguy, Jim37F and Mike97 like this.
  4. michael150

    michael150 Forum Crew Member

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    When a patient goes unconscious from an airway obstruction the purpose is still remove the foreign body. Chest compressions are initiated for that reason, not yet for resuscitative measures. As other responses have mentioned though, an unconscious patient due to an airway obstruction is ominous and very shortly they will become pulseless if a patent airway is not established.
     
  5. RocketMedic

    RocketMedic Fancy Book Learnin'

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    Depends on level and what/where the obstruction is. If you're an EMT, CPR, on the theory that compressions generate enough concussive force and pressure to dislodge an obstruction. If it's an oropharyngeal obstruction, remove it.

    If you're a paramedic, the world got big. Cut to air!
     
    medichopeful likes this.
  6. michael150

    michael150 Forum Crew Member

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    I would be interested to see how many medics have actually done a surgical or needle cric in the field... Would we actually be prepared for it?
     
  7. VentMonkey

    VentMonkey calpuleque Premium Member

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    Interestingly enough, I was listening to this past quarters Airway World webcast earlier. It’s pretty rare, however, current literature seems to advocate for surgical cric for apparent reasons.

    It was actually a pretty insightful webinar and focused on 3-4 prehospital related airway papers, but it was also quite lengthy.
     
  8. Peak

    Peak ED/Prehospital Registered Nurse

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    The difficulty with using compressions to force out a foreign body is that they would need to have relatively full lung volume when they became obstructed, otherwise there just isn't air to push out. We've had more than a few kids who started to breath in when a balloon popped and obstructed their airway without a significant amount of air in their lungs, in Japan we had an issue with kids sucking down these jello cup things that were just the right size to fit in and then obstruct the trachea.

    At a certain point the only options is direct visualization, trying to right mainstem whatever it is, or place a surgical airway. Surgical airways are a bloody mess, even when done right in a controlled setting, and are far from my preference. I have never had to actually perform one in the field, and we've never had to do one in the ED, but we have come close. Keep your skills up and start opening your cric kit to scare away the bad luck.
     
    michael150 likes this.
  9. michael150

    michael150 Forum Crew Member

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    I completely agree with the uses that it has in EMS and that we should all stay current on being confident in that skill. Is that webinar available for free somewhere? That would be great to listen to and read literature on it. As EMS evolves, I think it’s interesting to look at what data points to (i.e. should we ETT or just put in a supraglottic).
     
  10. VentMonkey

    VentMonkey calpuleque Premium Member

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    TheEleventhHour and michael150 like this.
  11. StCEMT

    StCEMT Forum Deputy Chief

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    One medic here did one a year or so ago. I came close last winter and that pt eventually did get one. The level 1 that happened at does a handful each year from what I understand. Definitely rare as a whole, but they do pop up here from time to time.
     
    michael150 likes this.
  12. michael150

    michael150 Forum Crew Member

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    May I ask where that is?
     
  13. StCEMT

    StCEMT Forum Deputy Chief

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    Richmond, Virginia. Busy city with outside counties coming in to the level 1. We also did a transfer for a botched croc from a small community hospital to the level 1, so I know of at least 3 within the last year here, not all done by EMS.
     
  14. CityEMT212

    CityEMT212 Forum Crew Member Premium Member

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    Hi Mike,

    We just talked about this in my EMT-B class yesterday since it was a CPR Course. My answer to you would be yes, still do compressions. The compressions would clear the airway and possible remove the obstruction. Also we discussed the order for an Unconsciouss patient is the A,B,C format, but if a patient "appears dead" (which was hotly debated in the class yesterday, then the format would then be C,A,B.

    Hope I (somewhat) helped.

    ~ Estrella
     
  15. phideux

    phideux Forum Captain

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    Last week we had a cardiac arrest due to anaphylaxis. We get on-scene and this guy is so swollen that his eyes are bugging out and his tongue is about 3" out of his mouth. Very weak bradycardic pulse. We hit him with his Epi pen, plus another .5mg and started CPR. Drilled him and started with the normal ACLS stuff. No compliance with bagging, 2 other medics tried tubing him but couldn't get a blade and tube in his mouth. Got him in the ambulance and we break out the CricKit. We got it done, It was a bloody mess, which helped a little, we followed the bubbles in with the tube. It worked, the doc said it was a bold move, but it was too little, too late. It is actually not a hard procedure to do, 2 cuts, grab the Trachea with the hook, stick in the tube, inflate and go.
     
  16. SpecialK

    SpecialK Forum Captain

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    I'd say because it's a pragmatic way to get some quasi-abdominal thrusts in.

    However, rather than bugger around with muppetry, it would be much more effective to just use a disposable laryngoscope and forceps to remove the obstruction. There have been several cases where this has been used successfully and I believe it's now common to all services in Australasia.
     
  17. VFlutter

    VFlutter Flight Nurse

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    I am not sure I would consider it a "bold move" since it was clearly indicated. Most say that the biggest mistake when doing a surgical airway is waiting too long. The decision to cut is the hardest part but really shouldn't be. If they need it, do it.
     
  18. RocketMedic

    RocketMedic Fancy Book Learnin'

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    Airway sucks and can't plausibly see? Cut to air!
     
    medichopeful likes this.
  19. StCEMT

    StCEMT Forum Deputy Chief

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    That bad of an airway, cric would probably get done before epi. No warm fuzzies there either way.
     

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