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Airway Obstruction Management & Supplies June 6,2019.

Sudden disasters and injuries happen. It is something all of us experience at some point. Each day there is a chance that a weather incident will cause an unplanned disaster; people fall and hurt themselves, equipment malfunctions, and random trouble is fully unpredictable. We are not trying to be pessimistic – randomness is an objective fact. That is why we at FirstCare Solutions believe it’s essential that everyone has some basic first aid supplies on hand and know how to properly use these supplies if needed. This could make the difference between casualties on one hand and saving lives with ease on the other.

The ABC of Resuscitation[1]

The most common type of accidents are scrapes and cuts. They cause bleeding, open up the possibility of infections and spreading of blood-borne diseases. Macerations can be a severe life threat; however, for a critical life-saving intervention triage of injury levels is necessary. By the time a person bleeds out, they might suffocate first. This is why our primary concern should always be airway management.

Airway, breathing, and circulation are all vital for life, and each is required, in that order, for the next to be effective. These are the essential steps used by both medical professionals and lay persons when dealing with a patient, which in its original form it stands for Airway, Breathing, and Circulation.

The protocol was originally developed as a memory aid for rescuers performing CPR and is common in taking care of an unconscious or unresponsive patient. Throughout history, a variety of differing methods of resuscitation had been attempted and documented until 1957 when Peter Safar, a doctor credited with pioneering cardiopulmonary resuscitation, wrote the book “ABC of Resuscitation” which established the basis for mass training of CPR.

Hypoxia is the state of insufficient oxygen in the blood and a potentially deadly condition, causing a cardiac arrest. Cardiac arrest is the ultimate cause of clinical death for all animals, according to the Encyclopedia of Death and Dying, and is linked to an absence of circulation in the body. For this reason, maintaining circulation is vital to moving oxygen to the tissues and carbon dioxide out of the body.

Airway, breathing, and circulation work in an observable feedback loop;

1. If the patient's airway is blocked, breathing will not be possible.

2. Oxygen cannot reach the lungs and be transported around the body in the blood.

3. This will l result in hypoxia and cardiac arrest.

Ensuring a clear airway is the first step in treating any patient; once it is established that a patient's airway is clear, a rescuer must evaluate the patient's breathing, as many other things besides a blockage of the airway could lead to an absence of breathing.

[1] As of 2010, the American Heart Association chose to focus CPR on reducing interruptions to compressions, and has changed the order in its guidelines to Circulation, Airway, Breathing (CAB).

Airway Management

Airway obstruction, or choking, is a life-threatening emergency that should always be evaluated first. Attention must first be brought to the airway to ensure it is clear. Choking can be caused by the tongue, the airways, foreign bodies obstructing the airflow, or from the body itself, via blood or aspiration.

If the patient is conscious, a first aid provider should check for the ability to speak or call out; if the breathing is wheezy, the airway produces a gurgling sound or cough. Visually, an individual might clutch at his own throat or turn blue from the lack of oxygen (state of cyanosis).  Basic treatment of a conscious person includes several procedures aiming at removing foreign bodies from the airways. Most protocols recommend encouraging the victim to cough, by hard back slaps. Do not dismiss the efficiency of back blows! The European Resuscitation Council recommends five blows between the shoulder blades. The back slap is designed to use percussion to create pressure behind the blockage, assisting the patient in dislodging the article. If none of these procedures work, one might try abdominal thrusts, the famous and often employed Heimlich maneuver to apply pressure to the bottom of the diaphragm. However, the Heimlich has potential to break ribs and should not be performed by an amateur. Other guidelines recommend alternating between the two, the abdominal thrusts and back slaps. If the choking is caused by an irritating substance rather than an obstructing one, and if the patient is conscious, she should be allowed to drink water on their own to try to clear the throat (since the airway is already closed, there is very little danger of water entering the lungs).

If the patient is unconscious, a first aid provider should prevent the tongue from falling back and obstructing the airways, by applying the head-tilt/chin-lift and jaw-thrust maneuvers (if cervical spine injury is not a concern).  The patient should be placed into the lateral recovery position to prevent aspiration of the stomach content or blood.

Recovery position before CPR

Recovery position - the mouth is downward so that fluid can drain from the patient's airway; the chin is up, supported by the hand to keep the epiglottis opened. Arms and legs are locked to stabilize the position of the patient.

Another way to make sure the airway is not obstructed is by deploying an oropharyngeal airway (OPA). Also known as the Guedel pattern airway or berman airway, it is used to maintain or open a patient's airway by preventing the tongue from covering the epiglottis, which could also prevent the person from breathing. In case of becoming unconscious, the muscles in a persons’ jaw relax and allow the tongue to obstruct the airway.

Guedel Oropharyngeal Airway

Following evaluation of the airway, a first responder should determine the adequacy of breathing and provide rescue breathing if necessary. At such times, she needs adequate emergency respiratory supplies to save the injured or critically ill person's life using resuscitators and ventilators.

Resuscitators are devices used to fill in the lungs with air in a person who is unconscious and not breathing to keep him/her alive. Resuscitators use positive pressure to make the patient who has compromised breathing to respire manually. These devices are used temporarily until the person is transferred to a ventilator.

Airway management equipment includes tools like nebulizers, CPR pocket masks, CPR face shield, portable ambu resuscitators, and oxygen delivery equipment including oxygen nasal cannulas and ventilators.


A nebulizer is a device used to administer a drug to a seriously injured or critically ill person in the form of a mist which the patient inhales into his lungs when breathing. It is used for the treatment of asthma, cystic fibrosis and a multitude of respiratory problems. It uses oxygen, compressed air, and ultrasonic power to break up solutions. These are then suspended into small aerosol droplets (a mixture of gas and liquid particles) that the patient inhales through the mouthpiece even when she is unconscious.

Nebulizer Face Mask

CPR Pocket Mask and CPR Face Shield

A CPR pocket mask is used to safely deliver air into a patient's mouth during the cardiac or respiratory arrest. It's a small device that can be packed into a first aid box and carried in hand. A CPR face shield can be placed into the patient’s mouth. The first aid responder positions the CPR face shield in the patient’s mouth and breathes through a one-way valve or a filter. The one-way valve protects the first aid provider from being infected by the patient, utilizing the incorporated viral and bacterial filter, along with a bite block that keeps the receiver’s teeth apart. It also assists in keeping an open airway while performing the head-tilt, chin-lift maneuver.

Oxygen delivery equipment

Patients in critical condition need to immediately receive oxygen through artificial ventilation. Oxygen delivery equipment consists of an oxygen tank, delivery mask, and nasal cannula. A nasal cannula (NC) is used to increase airflow and deliver supplemental oxygen to a patient. This device consists of a lightweight tube which on one end splits into two prongs which are placed in the nostrils and from which a mixture of air and oxygen flows. It can be hooked behind the patient’s ears. The other end of the tube is connected to an oxygen supply such as a portable oxygen generator.


Ventilators are chiefly used in intensive care medicine, home care, emergency medicine, and in anesthesiology. Mostly used in ICUs, ventilators are used to help patients in critical condition breathe in and out when they are unable to breathe by themselves.

Portable Manual Resuscitator

A manual resuscitator is a hand-held device used to provide positive pressure ventilation to patients who are not breathing. It is also known as the bag valve mask or Ambu bag.  It’s a required part of the resuscitation kit and often used in hospitals for anesthesia induction along with an anesthesia mask. It consists of an air-cushioned face mask and a “bag” attached via shutter valve. After applying the face mask, a first aid responder squeezes the bag and the device forces air into the lungs; it force-feeds air or oxygen into the lungs to inflate them under pressure. When the bag is released, it self-inflates form the other end, either with air, or with a low-pressure oxygen flow if a cylinder is attached. It is used to safely deliver air into a patient's respiratory system, without mouth-to-mouth ventilation that would require closer contact with a patient and possible viral consequence.

ambu bag

Continuous Positive Airway Pressure (CPAP)

CPAP is a form of positive airway pressure ventilator, which applies mild air pressure continuously to keep the airways open for people who are not able to breathe spontaneously on their own. The air is delivered through a CPAP nasal mask or a CPAP Full Face Mask. CPAP devices apply continuous positive airway pressure throughout the breathing cycle. This method of ventilation is used for people who have breathing problems, such as sleep apnea, or infants whose lungs have not yet fully developed, however, it does force a small amount of air pressure into the lungs causing them to reopen. Thus, it can be used for EMS as well.

Best CPAP Mask

Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (they can monitor pressure, volume, and flow of oxygen) and ventilator function (e.g., air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. Contemporary ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient's needs. Because failure may result in death, these mechanical ventilation systems are classified as a life-critical system, and precautions must be taken to ensure that they are highly reliable. They often come with manual backup mechanisms and safety valves to allow spontaneous patients breathing.

These and other respiratory supplies are essential for every emergency medical service provider in situations such as road accidents, plane crashes, fires, and flooding. When people are seriously injured or critically ill and unable to breathe on their own, immediate attention is necessary. Paramedics, for instance, are trained to keep the patients breathing and stabilized until a doctor is at hand to see them.

The airway assessment is the first part of the "ABC"s of first aid mentioned earlier, which focuses on critical life-saving intervention in the order of importance. ABC stands for Airway, Breathing, and Circulation, and the mnemonic is used by most  emergency health professionals. Other organizations teach the same order of priority using the "3Bs": Breathing, Bleeding, and Bones. The basic life support (BLS) principles has been the foundation of any healthcare professional and a way to recall the necessary activities under pressure and in dangerous situations. Preserving life, preventing further injuries, and promoting recovery has been standardized throughout the first aid movement worldwide, and a major part of that are the men and women working tirelessly to find the most efficient and safest ways to save lives. The ABCs of first aid are essential knowledge for just about anyone.

We have given an outline on airway management here, and in the next article we shall address the prevention of bleeding and triage of scrapes and cuts, the most common type of injury worldwide. Email us at info@firstcaresolutions.com for a free quote for all our airway management products!

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