Airway Management

Airway Management

Airway management is the process of ensuring that:

1. there is an open pathway between a patient’s lungs and the outside world, and

2. the lungs are safe from aspiration

[edit]Manual methods

[edit]Head tilt/Chin lift

The head-tilt chin-lift is the most reliable method of opening the airway.

The simplest way of ensuring an open airway in an unconscious patient is to use a head tilt chin lift

technique, thereby lifting the tongue from the back of the throat.

[edit]Jaw thrust

ILCOR no longer advocates use of the jaw thrust, even for spinal-injured victims. Instead, continue use of

the head-tilt chin-lift. If there is no risk of spinal injury, it is preferable to use the head-tilt chin-lift procedure

which is easier to perform and maintain.

[edit]Oral Airways

Oropharyngeal airways come in a variety of sizes; measure from the angle of the chin (or earlobe) to the corner of the

mouth.

There are a variety of artificial airways which can be used to keep a pathway between the lungs and

mouth/nose.

An oropharyngeal airway can be used to prevent the tongue from blocking the airway. When these

airways are inserted properly, the rescuer does not need to manually open the airway. Aspiration of

blood, vomitus, and other fluids can still occur.

It is only possible to insert an oral airway when the patient is completely unconscious or does not have a

gag reflex. If the patient begins to gag after inserting the oral airway, remove it immediately.

[edit]Use and contraindications

The correct size is chosen by measuring against the patient's head (from the earlobe to the corner of the

lips). The airway is then inserted into the patient's mouth upside down. Once contact is made with the

back of the throat, the airway is rotated 180 degrees, allowing for easy insertion, and assuring that the

tongue is secured. Measuring is very important, as the flared ends of the airway must rest securely

against the lips to remain secure.

To remove the device, it is pulled out following the curvature of the tongue; no rotation is necessary.

The airway does not remove the need for the recovery position: it does not prevent suffocation by liquids

(blood, saliva, food, cerebrospinal fluid) or the closing of the glottis.

The mains risks of its use are:

if the patient has a gag-reflex they may vomit

when it is too large, it can close the glottis and thus close the airway

improper sizing can cause bleeding in the airway

Correction: Airway is measured from the centre of the lips to the angle of the jaw. This is the international

method as used by ambulance services.

[edit]Bag-Valve-Mask (BVM)

See also: Oxygen Administration

A bag valve mask (also known as a BVM or Ambu bag, which is a brand name) is a hand-held device

used to provide ventilation to a victim who is not breathing. The device is self fills with air, although it may

be connected to an oxygen system.

Use of the BVM to ventilate a victim is frequently called "bagging." Bagging is regularly necessary when

the victim's breathing is insufficient or has ceased completely. The BVM is used in order to manually

provide mechanical ventilation in preference to mouth-to-mouth resuscitation (either direct or through an

adjunct such as a pocket mask).

[edit]Components

A bag-valve-mask

The BVM consists of a flexible air chamber, about the size of an American football, attached to a face

mask via a shutter valve. When the air chamber or "bag" is squeezed, the device forces air into the

victim's lungs; when the bag is released, it self-inflates, drawing in ambient air or oxygen supplied from a

tank. A bag valve mask can be used without being attached to an oxygen tank to provide air to the victim,

but supplemental oxygen is recommended since it increases the amount of oxygen reaching the victim.

Some devices also have a reservoir which can fill with oxygen while the patient is exhaling (a process

which happens passively), in order to increase the amount of oxygen that can be delivered to the victim

by about twofold. A BVM should have a valve which prevents the victim from rebreathing exhaled air and

which can connect to tubing to allow oxygen to be provided through the mask.

Bag valve masks come in different sizes to fit infants, children, and adults. Some types of the device are

disposable, while others are designed to be cleaned, disinfected, and reused.

[edit]Use

The BVM directs the gas inside it via a one-way valve when compressed by a rescuer; the gas is then

delivered through a mask and into the victim's airway and into the lungs. In order to be effective, a BVM

must deliver between 700 and 1000 milliliters of air to the victim's lungs, but if oxygen is provided through

the tubing and if the victim's chest rises with each inhalation (indicating that adequate amounts of air are

reaching the lungs), 400 to 600 ml may still be adequate. Squeezing the bag once every 5 seconds for an

adult or once every 3 seconds for an infant or child provides an adequate respiratory rate (12 respirations

per minute in an adult and 20 per minute in a child or infant).

Professional rescuers are taught to ensure that the mask portion of the BVM is properly sealed around

the patient's face (that is, to ensure proper "mask seal"); otherwise, air escapes from the mask and is not

pushed into the lungs. In order to maintain this seal, some protocols use a method of ventilation involving

two rescuers: one rescuer to hold the mask to the patient's face with both hands and ensure a mask seal,

while the other squeezes the bag. However, to make better use of available rescuers, the BVM can be

operated by a single rescuer who holds the mask to the victim's face with one hand (using a C-grip), and

squeezes the bag with the other.

When using a BVM, as with other methods of ventilation, there is a risk of overinflating the lungs. This can

lead to pressure damage to the lungs themselves, and can also cause air to enter the stomach, causing

gastric distention which can make it more difficult to inflate the lungs and which can cause the victim to

vomit. This can be avoided by care on behalf of the rescuer. Alternatively, some models of BVM are fitted

with a valve which prevents overinflation, by blocking the outlet pipe when a certain pressure is reached,

though they should all be able to be bypassed in a situation where more pressure is needed, such as in

anaphylaxis.

[edit]Suction Devices

In the case of a victim who vomits or has other secretions in the airway, these techniques will not be

enough. Suitably trained first aiders may use suction to clean out the airway, although this may not

always be possible. A unconscious victim who is vomiting or has copious secretions in the mouth should

be turned into the semi-prone position when there is no suction equipment available, as this allows (to a

certain extent) the drainage of fluids out of the mouth instead of down the trachea.

Airway clearance and exercise are an important part of the treatment for people with CF. Getting rid of the excess mucous that builds up in your lungs must be regularly scheduled into each day. A build up of mucous can lead to increased lung infections, decreased lung function, shortness of breath, decreased activity level, and more frequent hospitalizations.

Methods and Procedures

There are a number of ways to clear mucous from your lungs. Many of these are performed right after you have used your bronchodilator or other respiratory medicine. Which one is right for you? That depends on several factors, such as how you respond to therapies, your lifestyle, your physical condition, what devices are available to you, and your preferences. This section will review some airway clearance options that you may consider.

The methods described here are intended only as general information

The "best" therapy differs from person to person, and your treatments should be customized to meet your specific needs as determined by your physiotherapist. If you use any mechanical device or apparatus, look to the manufacturer's instructions for general treatment options and advice on how to maintain your equipment.

Conventional Postural Drainage with Percussion

Conventional postural drainage with percussion (PD&P), sometimes called clapping, is the original method of lung clearance. Postural drainage involves placing the patient in a downward position that allows gravity to help move the mucous from the small airways to the larger airways (six to twelve positions are usually used, depending on the area of the lung you are draining). While the patient is in a postural drainage position, percussion is done on the chest wall anywhere from three to ten minutes to aid in dislodging the mucous. Vibrating the hands on the chest while the person is breathing out is also incorporated into the treatment, which helps to move mucous further into the larger airways. Finally, the person sits up and performs huffing exercises and effective coughing to help clear the loosened mucous. The treatment is divided into two or three daily sessions. It usually requires the help of another person, but some adult patients can do it alone by using a mechanical percussor.

Autogenic Drainage

Autogenic (self) drainage (AD) is a method that uses controlled breathing to move the mucous out of your lungs. It does not need any equipment and you can do it by yourself. With this method, you are taught to breathe at three specific lung volumes. The first begins with low lung volume to "unstick" the mucous deep in your lungs. From there, you move to mid lung volume to "collect" the mucous that loosened in the first stage. In the last stage, you use high lung volume to "expel" (remove) the mucous.

With AD, it's important to adjust how fast you breathe out at each level so that you reduce airway compression (tightening) when exhaling. The goal is to achieve a mucous "rattle" rather than a whistling "wheeze," which would mean your airways are getting tight. Perfecting an AD technique needs training and frequent review. It can be a good method for people who can concentrate well and are healthy enough not to become overly tired while performing it. This method can also be adjusted somewhat for people with poor lung function.

Positive Expiratory Pressure

Positive expiratory pressure (PEP) is a form of chest physical therapy that uses a device consisting of a mask or a mouthpiece, and a one-way valve with a resistor attached to the expiratory outlet. When performing PEP Therapy, you breathe in and out through the device approximately 15 times/cycle.

Breathing out creates a positive pressure (back pressure) in your airways, which helps open small airways and air sacs deep in the lungs. These small airways and air sacs might otherwise remain closed because of mucous blockage.

When learning PEP Therapy, you first learn relaxed abdominal breathing. Breathing through the PEP device should be slightly active, meaning you will have to use some force. However, you don't have to use the same amount of force as you do with your Pulmonary Function tests. Form a good seal with the mask or mouthpiece (using nose plugs) and breathe out through the flow resistor so that you maintain the correct pressure (which is shown by a meter). This is repeated 15 times. Then learn the "huff" maneuver (an exercise that is similar to forcefully fogging a window with your breath), using your breath to move and then cough up the mucous that had been blocking your airways. These steps are then repeated approximately five to six times.

Active Cycle of Breathing

Active cycle of breathing therapy (ACBT) combines three breathing methods to move mucous out of your lungs:

1. breathing control (gentle relaxed breathing)2. thoracic expansion exercises (deep breaths, often with a

three-second-breath hold and a quiet unforced breath out)3. the forced expiration method (breathing out one or two huffs)

These three steps are done in sequence to loosen and expel the mucous, then repeated for a time period designated by your physiotherapist or until you feel you can no longer cough up any more mucous. Some people may need to use gravity-assisted positions with this method. One advantage of this method is that you can do it on your own with no equipment. People with CF can also perform it even if they have poor lung function.

Oscillating PEP (Flutter®)

The Flutter is a small handheld pipe-shaped device that has a hard plastic mouthpiece at one end, a perforated plastic cover at the other, and a stainless-steel ball resting in a plastic cone on the inside. It is portable and relatively inexpensive and can be used on your own. The Flutter helps airway clearance by:

vibrating the airways to loosen mucous keeping the airways open during exhalation (breathing out) creating "mini-coughs" to promote mucous removal

The Flutter is used in a sitting position. You hold it horizontally, take a deep breath in and hold it for two to three seconds before breathing out actively into the device. You can adjust the degree you hold the device at to feel the maximum amount of vibrations in your airways. You repeat this step for ten to twelve breaths, and then perform one to two huffs through the device, followed by coughing. This whole cycle is then repeated for a time period designated by your physiotherapist or until you feel that you can no longer cough up any more mucous.

The Flutter can be combined with other methods of airway clearance and is often very effective in stimulating a cough in those patients who are having difficulty coughing.

The Acapella is also a small handheld plastic device that comes in two colours - blue and green. Which model you should use depends on your expiratory flow (ask your physiotherapist). This device uses a counterweighted plug and magnet rather than a steel ball. It combines the features of the PEP device and the vibratory features of a flutter valve to move mucous out of the airways. Because it's not dependent on gravity, it can also be held at different angles. Unlike the other techniques listed above, this airway clearance method has not been as well researched with patient studies. Therefore, further research is needed to assess its effectiveness for people with CF.

High Frequency Chest Wall Oscillation (vibration) (HFCWO)

HFCWO uses a mechanical chest wall oscillator (vibrator). It consists of two parts, an inflatable vest and an air pulse generator. Pulses are created by the generator to inflate and deflate the vest, creating high-frequency chest wall oscillations (vibrations). You can use this device without the help of another person. However, it's not easy to carry around, is expensive, and its price may not be covered by your insurance. The vest can be used with other methods of airway clearance as well as during activities such as reading, watching TV, or surfing the Internet.

Inhalation Therapy

Inhalation therapy is an important part of the treatment in CF. When doing your inhalation treatment, you should sit upright with good posture and use relaxed abdominal breathing. The compressor and nebulizers recommended by your physiotherapist or respiratory therapist, should be used following the instructions properly.

Most people should be able to use a mouthpiece rather than a facemask with their nebulizer. This will help deliver more medication into the lungs rather than filtering it through the nose and losing some of the medication into the air. Strict cleaning guidelines should always be followed.

Inhalers may also be prescribed which require you to take a deep inspiration (breathing in) and hold your breath for ten seconds. A device called a "spacer" should be used with inhalers when possible, to insure the medication gets into your lungs.

Exercise is very important for people with CF. It can help improve mucous clearance in some people, maintain or even improve lung function, and give you a sense of well being. Try to make it a part of your daily routine as much as possible. Aim for a routine that combines endurance training with strengthening and flexibility, and that is in harmony with your ability and interests.

Postural exercises and education should also be a part of your program to try and prevent back pain that can be associated with CF. Do keep in mind however, that exercise does not replace airway clearance treatments.

Summary

Airway clearance and exercise are an important part of the daily regimen for people with CF. Remember — all the methods listed above need proper instruction from a qualified person and motivation on your part to be effective. In many cases, breathing exercises and a device can be combined. For example, you could use a Flutter in the morning, and clapping in the afternoon. Not all methods are right for everybody. Talk to your physiotherapist to see what's best for you. You may want to try a few methods until you find one or more that you feel comfortable with and that seem to offer you the most benefit. No matter what methods you use, you should always have regular check ups with your physiotherapist to review your technique and equipment. Your treatment may change in the hospital.

Reference

The information in this article was adapted from an article by Jim Bolek, RRT CF Care Path Manager, Rainbow Babies' and Children's Hospital, Cleveland, Ohio (Genentech's CF Toolbox)

CPR Technique to Open AirwaysBy Michael O. Smathers, eHow Contributor

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Steps for CPR Air Berlin Airways

Cardiopulmonary resuscitation, or CPR, can be an invaluable life-saving technique. It clears the airway and forces your heart to pump blood through the body until a rescue team can arrive to take over. You can learn CPR techniques from your local Red Cross or at a swimming pool, because

lifeguards perform these techniques to save people from drowning. Learning how to perform CPR may enable you to save a life.

1. Open the Airwayo According to the ACEP (American College of Emergency Physicians) Foundation, CPR consists of

three main steps: opening the airway, using rescue breathing and performing chest compressions and rescue breathing. The airway has to be open for rescue breathing or chest compressions to have positive effect. To clear the airway, roll the person onto his back, tilt his chin and press down on the forehead. Now you can perform rescue breathing to provide oxygen to the lungs. Don't tilt his head if a neck or back injury has occurred, because you could risk killing him. The chin lift may still be performed. If the airway still fails to open, try tilting the head in a slow and gentle manner until the airway no longer is blocked.

Rescue Breathingo Listen and watch for signs of breath. Listen for normal breathing in a healthy adult by placing one ear

to her mouth and nose and watching her chest for rising and falling motions. If you have to perform CPR on a child or infant, listen for any breathing. If you don't notice any breathing, put the heel of your hand on her chin to keep the airway open. Pinch her nose shut and breathe twice into her mouth. Pause between breaths to see if she responds to aid. If you perform rescue breathing correctly, her chest should rise and fall.

Chest Compressiono Rescue breathing gets oxygen into the lungs. Chest compressions force the heart to circulate that

oxygen through the body. Immediately after doing rescue breathing, place the heel of your hand on his sternum and reinforce it with your other hand. Press directly downward on the sternum 30 times, then give two more breaths and repeat chest compressions. Do this quickly enough to give 100 compressions in one minute to simulate heart rate. Continue until help arrives, until your CPR takes effect or until you've exhausted yourself. Do not stop under any circumstances unless you are unable to continue.

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References ACEP Foundation - How to Perform CPR

Read more: CPR Technique to Open Airways |

eHow.com http://www.ehow.com/way_5681702_cpr-technique-open-airways.html#ixzz1dNfsRHob

Opening the AirwayMany problems of airway obstruction, par-ticularly those caused by the tongue, can be cor-rected simply by repositioning the head and neck.If repositioning does not alleviate the problem,more aggressive measures must be taken. NOTE:Before going further, it is imperative that cor-psmen remember to check all victims for possiblespinal injuries before any repositioning is at-tempted. If there is no time to immobilize theseinjuries and the airway cannot be opened with thevictim in the present position, then great care mustbe taken when repositioning. The head, neck, andback must be moved as a single unit. To do this,adhere to the following steps (see figure 4-2).Kneel to the side of the victim in line withthe victim’s shoulders but far enough awayso that the victim’s body will not touchyours when it is rolled toward you.Straighten the victim’s legs, gently butquickly.Move the victim’s closest arm along thefloor until it reaches

straight out past thehead.Support the back of the victim’s head withone hand while you reach over with theother hand to grab the far shoulder.Figure 4-3.—Head

tilt.Figure 4-4.—Jaw thrust.. Pull the far shoulder toward you while atthe same time keeping the head and neckin a natural straight line with the back. Thehead resting on the extended arm will helpyou in this critical task.Head TiltThe head tilt technique of opening the airwayis a simple repositioning of the head. With thepatient lying down, place one of your hands onhis or her forehead and apply gentle, firm,backward pressure using the palm of your hand.With your other hand under the victim’s neck,lift the neck (fig. 4-3). This will lift the patient’stongue away from the back of the throat and pro-vide an adequate airway. NOTE: This techniqueis not recommended for patients with suspectedneck or spinal injuries.Jaw thrustA second technique for opening the airway isthe jaw thrust. This technique is accomplished bykneeling by the top of the victim’s head and plac-ing your fingers behind the angles of the lowerjaw (fig. 4-4A), or hooking your fingers under thejaw (fig. 4-4B), then bringing the jaw forward.Separate the lips with your thumbs to allowbreathing through the mouth as well as the nose.This technique is to be used if a neck injury issuspected.Either the head tilt or the jaw thrust will of-fer some relief for most forms of airway obstruc-tion. They also prepare the airway for artificialventilation.If the airway is still seriouslyobstructed, it may be necessary to try to removethe obstruction by using the abdominal thrust orchest thrust methods indicated for opening a com-pletely blocked airway.

LIFE SUPPORT FOR ADULTS AND PAEDIATRICS

Due to recent changes in resuscitation, I have put links to the resuscitation council website to view the current guidelines for Adult and Paediatric life support.

Adult Life Support Paediatric Life Support

These links will open a new window

AIRWAY MANAGEMENT

Obstruction of the airway

An unconscious casualty has no control over his or her muscles, including the muscles that control the tongue. The relaxed tongue will fall backwards across the airway, and cause an obstruction. If a breathing unconscious casualty remains on his or her back, the risk of airway obstruction is increased.

An unconscious casualty may also have material in the mouth such as food, blood or vomitus, which may obstruct the airway. It is vital that if such material is present it is removed as soon as possible.

Ensuring an open Airway

Head Tilt/Chin Lift

Head tilt-chin lift manoeuvre is the primary method used to open the airway. To perform the head tilt-chin lift manoeuvre, place one of your hands on the patient’s forehead and apply gentle, firm, backward pressure using the palm of your hand. Place the fingers of the other hand under the bony part of the chin. Lift the chin forward and support the jaw, helping to tilt the head back. This manoeuvre will lift the patient’s tongue away from the back of the throat and provide an adequate airway.

Jaw Thrust

The jaw-thrust manoeuvre is considered an alternate method for opening the airway. This manoeuvre is accomplished by kneeling near the top of the victim’s head, grasping the angles of the patient’s lower jaw, and lifting with both hands, one on each side. This will displace the mandible jawbone) forward while tilting the head backward.

Artificial Airways

Also known as airway adjuncts. 3 types are commonly used by technicians, these are:

Oro-Pharyngeal

Naso-Pharyngeal

Laryngeal Mask Airway

Oro-Pharyngeal (OP)- are used to maintain the airway in the unconscious patient during bag and mask ventilation. They are:

inserted upside down until the tip is beyond the end of the tongue

rotated 180 degrees into position

At all times the patient's airway is maintained by the hand not holding the device: holding the mouth open and jaw forward.

An oropharygneal airway is functionally-dependent upon getting the right size; measure from angle of mouth to ear and size the airway against this distance.

Airway Sizes

00 = Babies

0 = Infants

1 = Children

2 = Small Adults

3 = Large Adults

4 = V Large Adults

Naso-Pharyngeal (NP) - may be used on conscious victims since it is better tolerated because it generally does not stimulate the gag reflex. Since it is made of flexible material, it is designed to be lubricated and then gently passed up the nostril and down into the pharynx. If the airway meets an obstruction in one nostril, withdraw it and try to pass it up the other nostril.

Laryngeal Mask Airway (LMA) - is used for the purpose of airway management and sits tightly over the top of the larynx it is used as an alternative to Endotraceal Intubation (ET). Although used as an alternative it is believed that it is not as good at

securing an airway as the ET route due to the fact it may not protect the airway from aspiration of vomitus. Some ambulance services allow a technician to use this form of adjunct to protect an airway whereas others may not due to the belief that theatre time is required to 'master' it's insertion, although it may be said that the experienced clinician can easily teach the inexperienced how to insert the LMA correctly.

Inserting the LMA:

Insertion of an LMA  (Link to External Site)

Finger Sweep

Probably the simplist means for removing a foreign body can be done by performing a “finger sweep.” This procedure, however, must be performed on unconscious victims only (though not on patient having an epileptic seizure).

Suction - Used for removal of fluids in the mouth e.g. Blood or vomit

Back Slaps, Abdominal Thrusts - See procedure for a choking patient below

Choking Patient - Adult

If blockage of the airway is only partial, the victim will usually be able to clear it by coughing, but if obstruction is complete urgent intervention is required to prevent asphyxia.

Victim is conscious and breathing, despite evidence of obstruction:

Encourage him to continue coughing but do nothing else

Obstruction is complete or the victim shows signs of exhaustion or becomes cyanosed:

If the victim is conscious:

Carry out back blows:

Remove any obvious debris or loose teeth from the mouth

Stand to the side and slightly behind him

Support his chest with one hand and lean the victim well forwards so that when the

obstructing object is dislodged it comes out of the mouth rather than goes further down the

airway Give up to 5 sharp blows between the scapulae (shoulder blades) with the heel of your

other hand; each blow should be aimed at relieving the obstruction, so all 5 need not

necessarily be given.

If the back blows fail, carry out abdominal thrusts:

Stand behind the victim and put both your arms around the upper part of the abdomen

Make sure the victim is bending well forwards so that when the obstructing object is

dislodged it comes out of the mouth rather than goes further down the airway.

Clench your fist and place it between the umbilicus (navel) and xiphisternum (bottom tip of

the sternum). Grasp it with your with your other hand

Pull sharply inwards and upwards; the obstructing object should be dislodged

If the obstruction is still not relieved, recheck the mouth for any obstruction that can be

reached with a finger, and continue alternating 5 back blows with 5 abdominal thrusts.

If the victim at any time becomes unconscious:

This may result in the relaxation of the muscles around the larynx (voicebox) and allow air to pass down into the lungs. If at any time the choking victim loses consciousness carry out basic life support:

Choking Patient - Child

There are a number of different foreign body obstruction sequences each of which has its advocates.

If the child is breathing spontaneously his own efforts to clear the obstruction should be encouraged. Intervention is necessary only if these attempts are clearly ineffective and breathing is inadequate.

Do not perform blind finger sweeps of the mouth or upper airway as these may further impact a

foreign body or cause soft tissue damage

Use measures intended to create a sharp increase in pressure within the chest cavity, an artificial

cough

1. Perform up to FIVE back blows

Hold the child in a prone position and try to position the head lower than the chest with the airway in

an open position

Deliver up to five smart blows to the middle of the back between the shoulder blades

If this fails to dislodge the foreign body proceed to chest thrusts.

2. Perform up to FIVE chest thrusts

Turn the child into a supine position, again with the head lower than the chest and the airway in an

open position

Give up to five chest thrusts to the sternum:

The technique for chest thrusts is similar to that for chest compressions.

Chest thrusts should be sharper and more vigorous than compressions and carried out at a

rate of about 20 per minute.

3. Check mouth

After five back blows and five chest thrusts check the mouth

Carefully remove any visible foreign bodies.

4. Open airway

Reposition the airway by the head tilt and chin lift (jaw thrust) manoeuvre

Reassess breathing.

5A. If the child is breathing

Turn the child on his side

Check for continued breathing

5B. If the child is not breathing:

Attempt up to 5 rescue breaths to achieve 2 effective breaths each of which makes the chest rise

and fall.

The child may be apnoeic or the airway partially cleared, in either case the rescuer may be able to

achieve effective ventilation at this stage

If the airway is still obstructed repeat the sequence as follows:

For a child

Repeat the cycle (1-5 above) but substitute 5 abdominal thrusts for 5 chest thrusts

Abdominal thrusts are delivered as 5 sharp thrusts directed upwards towards the diaphragm

Use the upright position if the child is conscious; kneel behind a small child

Unconscious children should be laid supine and the heel of one hand placed in the middle of

the upper abdomen

Alternate chest thrusts and abdominal thrusts in subsequent cycles

Repeat the cycles until the airway is cleared or the child breathes spontaneously.

For an infant

Abdominal thrusts are not recommended in infants because they may rupture the abdominal viscera

Perform cycles of 5 back blows and 5 chest thrusts only

Repeat the cycles until the airway is cleared or the infant breathes spontaneously.

Logroll technique

CLINICAL TEAM: Mark Gillespie, Brian McFeteridge,

Stephanie Duleavey, Andrea Sheppard

Background Brief

This method is common in A&E

situations particularly. It is a

method of lifting a patient from the

scene of an accident onto a

stretcher or movement of a patient

while on a bed to allow access to

the back or lower limbs for specific

treatment. There is great risk to

both patient and nursing staff

during this activity. From the

patient point of view, if spinal

trauma has occurred, during a lift

sequence permanent damage can

occur, through spinal cord damage

caused by instability of the spine

during motion. In terms of the

nursing staff. It takes 4 people to

make the lift which exerts a range

of forces on the back from stooping,

reaching and twisting as they try to

maintain the alignment of the spine.

Sometimes the general public will

be enrolled to assist, for example at

an emergency roadside situation. All

management of the lift is controlled

by the nurse at the patients head.

There are different aspects to

consider during this process, which

may include several different

product enhancements/ inventions.

1. Stability of the posture. It is

important that the injured

person remains as closely as

possible to their found

posture. Body motion can

lead to spinal cord damage if

any part of the

musculoskeletal structure is

instable. What type of

products could be proposed,

which form an apparatus to

stabilize the posture, prior to

the logroll lift?

2. The process of the logroll lift

is strenuous to the nursing

staff, particularly if the

patient is heavy, or large.

Grip can be compromised

and their shoulder and back

can become strained. What

type of products could be

proposed that form a support

or grip apparatus for users?Case Study Things to consider

It’s a cold, wet November evening

and its dark. There has been a Road

Traffic Collision (RTC) on one of the

B routes outside of Derry. Lying on

the ground, he is still conscious but

is complaining with neck pain. It

must be presumed that he has

spinal injuries until otherwise

proven. Universal precautions are

initiated in order to protect the

cervical spinal region. He has been

gently placed onto a stretcher by

the ambulance and transported to

the hospital. When he arrives at the

local A&E department he is required

to be log rolled to examine his

cervical, thoracic and lumbar

regions of the spine. This involves

the team leader holding the

patient’s head and neck in a neutral

position to prevent ANY movement,

which often causes them low back

pain and can result in slight head

and neck movement of the patient

which should be avoided.

• Stability of head, body and

legs (possible motions include

axial rotation, lateral bending

and flexion/ extension)

• Prevention of head motion

• Prevention of leg movement

• Constrain position of spine

rigidly

• Speed of apparatus set up

• Available access around body

parts for apparatus set up

• Visual communication coding

for injured zones and/ or

instructional coding

• Create gripping support

• Transfer to spineboard

• Supports to aid stability on

Spineboard