50- primary assessment Airway

KYJ 50 - Airway.
Part 1 of 5 part series on Primary Survey.
Airway and simultaneous C-Spine precautions.

Few clinical staff will refute that priority of patient assessment starts with assessing Airway.
As the first step in a primary and secondary survey, airway assessment is the Alpha priority.

Today's trauma pearl is the first instalment in a five part series that looks at this step in detail.
The arrival of a trauma patient presents many challenges to EMS and nursing staff.  Exposure to fuel, chemicals, blood and other body fluids, anxious and aggressive patients or relatives, well meaning yet obstructive first responders; all these things are safely risks that need to be managed before prioritising patient assessment.

Getting down to airway assessment the emergency responder first needs to recognise that opening a patients mouth to inspect the airway requires a technique that avoids head tilt. In trauma (especially when the patient was knocked out), protecting the cervical spine integrity is vital, so opening an airway using a full head tilt (as you were taught in first aid or basic life support courses) is s No No.

Chin lift or Jaw thrust are both techniques that can be used to open the mouth, and lift the tongue away from the pharynx. With a patient lying supine, these techniques will open the airway temporarily allowing you to assess for foreign obstruction.

What are you looking for?
Anything you see in the airway will fall into one of three categories.
Wet n sloppy -(blood, secretions, vomit)
Hard n Chunky- (broken off teeth, windshield glass, food, gum, vomit)
Soft n fleshy- ( tongue, oedema, vomit)

Once an obstruction has been found, remove it.
Wet n sloppy - Yankeur or rigid sucker to gently suction the oropharynx
Hard n chunky - Magills forceps or, if safe, your gloved fingers (caution against this if broken teeth or glass is likely)
Soft n fleshy - insert an airway adjunct such as a nasopharyngeal , guedels airway(OPA), LMA, or oesophageal airway, if the patient is unable to control their own tongue.
Definitive airway security is the insertion of an Endotracheal Tube (ETT).

Failure to establish an effective patent airway, may require an emergency surgical airway (tracheostomy).
Not until the patient's airway is secure, should assessment of the patient continue.

Summary: remember, wet n sloppy, hard n chunky, & soft n fleshy.
The Airway is your top priority.