Disaster and Military Medicine Department

Guzar,2
“PREMEDICAL AID IN EXTREME
SITUATIONS”
Topic 3. Lesson 2

VIOLATION OF AIRWAY
PATENCY
Levels and reasons of obstruction
1. Upper airways (oral and nasal
cavity, pharynx)
– Tongue, soft palate, epiglottis
(loss of the
muscle tone)
– Trauma
– Foreign body
– Edema of the soft tissues
– Blood, vomit
2. Larynx
– Laryngospasm (reflex
due to
irritants inhalation)
– Foreign bodies
– Trauma
– Edema (due to burns,
asphyxia, inflammation)
3. Trachea and bronchi (rare)
– Blood, edema, spasm
– Gastric aspirate
– Trauma
What kinds of
obstruction?
 Partial
 Wheeze (upper airways and larynx obstruction)
 Gurgling (liquid in upper airways)
 Snoring (muscle tone loss of the soft palate/epiglottis/tongue)
 Laryngeal whistle (laryngospasm, laryngeal obstruction)
 Whistle on exhale (lower airways obstruction)

Absolute
 Paradox movements of the chest and abdomen (inhale- chest
compression/abdomen inflates; exhale – vice versa)
 Visualization of the neck, chest muscles involvement into the act of
breathing
 No air movement
 Loss of consciousness
ASPHYXIA
Asphyxia is a condition caused by complete cessation of
oxygen coming in the lungs, which is critical for 2-3 minutes. As a
result of oxygen starvation following cardiac arrest and death occur.
The word ‘asphyxia’ has originated from Forensic Medicine
and used particularly for death events related to suicides.
Suffocation is the term nearly used with asphyxia. The other word is
strangulation which is defined as compression of airways or blood vessels in the
neck, leading to asphyxia due to neuronal death.
PREMEDICAL AID TO THE VICTIM WITH
BREATHING VIOLATION
1. If a victim is conscious and breathes on his own, count an amount
of inhalation or exhalation during 15s. If the frequency of breathing is
less than 2 breathing cycle during 15 s. ( 1 breathing cycle is
inhalation and exhalation), put nasopharyngeal air conduit and put
victim on a side.
2. If a victim is conscious and breathes on his own, and you hear
him
wheezing or gurgling, put nasal tube and put victim on one side.
3. If a victim is unconscious, put nasopharyngeal via conduit and put
him on one side.
4. If a victim doesn’t breathe and he doesn’t have any ingrained
injury of
thorax, examine pulse on the carotid.
5. If there isn’t pulse, stop trying to save him.
6. If there is pulse, try to do artificial breathing.
7. If victim doesn’t breathe, he has an ingrained injury of thorax and
he
STANDARD METHOD OF OPENING RESPIRATORY WAYS
is to throw back head and lift a chin.
 Stand up on your knees near the victims shoulder.
 Put one hand on his forehead and firmly press on it by a palm, throwing back his
head.
 Put fingers of your other hand under the chin and lift it up.
 Move a jaw forward till the upper and lower teeth stand together. Mouth can’t be
closed because it should hinder breathing in case nasal breathing tracts are
blocked or damaged. If it is necessary push a lower lip by your big finger to take
a mouth opened.
 If you see foreign things (incused teeth, prosthetic appliance from teeth splinters of
face’s bones or vomiting which can block breathing tracts). in a victim’s mouth.
Pull them out immediately.
 “CHAIN» OF SURVIVING

1. Make sure in our own safety;

2. Check the victims consciousness;
3. Shake carefully on the shoulder;
4. Ask “Are you okay?”
5. If there is an answer, leave victim in the position that you found him.
6. Find out a reason of what’s happened;
7. Always keep up with victim’s state;
8. Call for help;
9. Restore the permeability of upper respiratory ways;
10. Check the breathing;
11. Call 103;
12. Make a chest compressions and artificial breathing (30 pushes on 2
inhalations).
 Methods of mouth to mouth or mouth to nose

1. For providing an artificial respiration it is necessary to put the victim on his

back, unbutton clothes that clutch his chest and check the patency of the
upper airways.
2. For freeing airway the victim’s head of should be thrown.
3. If in the mouth or throat, there is a foreign object, it must be quickly
removed with your finger, which is wrapped in a napkin or handkerchief.
4. For suction an extraneous content you can use a rubber syringe, cutting its
advance thin end.
5. For a fuller opening of airways you need to bring the lower jaw forward.
6. If you have an air pipe, it should be placed into the throat to prevent
retraction of the tongue. Without air pipe during respirator you should hold
victim’s head in the space arm position, displacing the lower jaw forward.
Methods of mouth to mouth or mouth to nose

7. Whoever make resuscitation, should take a deep breath and pressed tightly
his mouth to mouth, blown air into the lungs, and the hand that is located at
the the victim’s forehead, must pinch the nose.
8. Exhale is carried passively by the forces of elasticity of the chest.
9. The number of breaths per minute should be at least 16-20.
10.To avoid direct contact with the victim's mouth you can blow air through
gauze, handkerchief or any other loose cloth.
11.In conducting the breathing method of mouth to nose blowing of air is
carried through the nose. In this case, the victim's mouth must be closed by
a hand, which simultaneously shifts jaw up to prevent retraction of the
tongue.
12.Check the carotid pulse about every 12 breaths (approximately every
minute). Beating heart rate means that the heart is still pumping blood.
When checking the pulse and check whether the wounded began to
breathe by himself.
Methods of mouth to mouth
 Methods mouth to mask

• Restrictions
–
Increases the ventilation
effectiveness
– Allows to avoid direct contact of a
rescuer and a victim
– Allows to minimize
 rescuer’s contamination
– Allows to increase Fraction of
Inspired Oxygen (FiO2)
–

Maintenance of the air- tightness

– Ingress of the air into the
 victim’s stomach
PNEUMOTHORAX – the accumulation of air in the pleural
cavity and increased pressure in it. The air can enter
the pleural cavity with injuries that penetrate the chest.
There are several types of
pneumothorax:
 Open,

 Closed (tight),
 Tight (valve).
 Open pneumothorax
 With open pneumothorax, the pleural cavity is interconnected with the
external environment, so it creates a pressure equal to atmospheric
pressure. In this case, the lung decreases, because the most important
condition for lung exertion is negative pressure in the pleural cavity. The
lung is removed from the act of breathing, there is no gas exchange in it,
and blood is not enriched with oxygen. It can accompany by
hemothorax
– the presence of blood in the pleural cavity.
 The open pneumothorax should be closed by occlusion dressing. Ask
the
wounded to take a deep breath. In the absence of a foreign object in the
wound, press the palm to the wound and close the air's access to it. If
the
wound is cut through, close the inlet and outlet openings of wound.
 Close the wound with a bandage that does not let air (you can use a
plastic bag or a plastic wrapper). If this is not at hand, take a napkin,
cloth or anything from clothing. Secure the bandage with the adhesive
INTRODUCTION OF NASOPHARYNGEAL AIRWAY
 Nasopharyngeal airway provides air access to the airways,
prevents the tongue from falling and overlapping air access. The
tongue of a wounded person who is in an unconscious state
can relax, block
the airways, because the west is inside and will block the lumen
of the
trachea (respiratory throat).
The technique of introducing nasopharyngeal airway:
 Turn the wounded back to face up.
 Lubricate the air line with sterile gel (lubricant) or water.
 Determine the size of the tube.
 Expand the nasal hole of the wound by forming a pig tip.
 Introduce the nasopharyngeal airway. Usually, for the first
attempt,
use the right nostril.
 INTRODUCTION OF NASOPHARYNGEAL AIRWAY
 Insert the end of the air duct into the
nostrils.
 Put the air duct so that the inclining
(sharpened end) is directed toward the

membrane (the septum in the nasal

separating nose).
 Introduce the air duct in the nostril and push
it so that the bent edge adjoins the nostril.
 Fix the air duct with a piece of sticky tape.
 Remember that it is impossible to push the
air in the nose of the injured with the force. If
you feel resistance, pull out the air duct and
try to enter it in the other nostril. If you
cannot enter the air duct into any nostril, put
the injured in a position on the side (stable
position).
 Put the wounded in a stable position and
call for medical assistance.
Contraindications to using
nasopharyngeal air duct:
It is cannot be used in cause of head
injuries (damage to the palate or open head
injury).
Not use if clear liquid flows from the nose
or ears. This may be a cerebrospinal fluid.
This may indicate a skull fracture.
Conicotomy - is a median dissection of the larynx between the
rectum and thyroid cartilage within the cricoid cartilage

Indications for conicotomy: stenosis of the larynx of a different

nature (inflammatory, allergic, tumor, etc.), with a severe violation
of the respiratory function, when there is no time or conditions for
tracheotomy. Breathing with this often, breath and exhalation
occur with tension and accompanied by whistling noise. The
muscles of the neck, shoulder girdle and chest (stenosis of the
3rd degree larynx) are involved in breathing. Difficulty breathing
can grow rapidly up to a complete stop; delay in conicotomy in
such cases is unacceptable.
Conicotomy
TECHNIQUE OF CONICOTOMY
Conduct in a lying position, however, often sitting in position, if it improves
the condition of the patient.
Palpatory determine the localization of the arch of the cricoid cartilage
and the lower edge of the thyroid gland.
A scalpel with a narrow blade is placed vertically along the middle of the
neck, immediately above the arch of the cricoid cartilage with the cutting
side up and engage one lance in a larynx to a depth of 1.5 cm, but not
more than 2 cm, cutting all the tissues of the front wall of the larynx; the
incision can begin from the lower edge of the thyroid cartilage.
Without pulling out the scalpel, the incision continues a few millimetres up
to the lower edge of the thyroid cartilage (sometimes the cut is made
horizontal), to avoid damage to the back wall of the larynx, the warp is
tightly wound on the scalpel base, leaving only 1.5-2 cm of its blades open.
After removing the scalpel, the incision is first introduced as an expander
such as Truss, and then a tracheostomy tube.
Remember that all actions should be not only fast but also cautious
because the lower arch of the cricoid cartilage is a thyroid gland, the
wound of which is accompanied by severe bleeding..
Conicocricotomy or cricotomy –
a kind of conicotomy is a dissection along
the midline of a cricoid cartilage gut.
In patients with short and thick neck, as
well as in women and children, it is
sometimes impossible to determine the
palpation of the arch of the cricoid
cartilage. In such cases, they are guided
by the lower edge of the thyroid cartilage.
The scalpel is placed vertically, with the
cutting side down to the median line
immediately under the edge of the thyroid
cartilage. Then they roll up to a depth of
2 cm and, without pulling out the scalpel,
cut the incision down to 5-6 mm; At the
same time, the arch of the cricoid
cartilage is broken down. As a result of
this operation a wider aperture is
obtained than with conicotomy. However,
after cricotomy, violations of the voice
may occur, so they resort to it extremely
rarely.
DROWNING - death due to hypoxia, which occurs as a result of the
closing of the respiratory tract with a liquid, most often with water.
Drowning is possible when bathing in water, although sometimes it
occurs in other conditions, for example, when immersed in a bath or a
container with some other liquid. The victim can be saved if timely and
correctly give him first aid. In the first minute after drowning in the water
can save more than 90% of victims, after 6-7 minutes, only 1-3%.
 Two basic varieties of drowning are distinguished:
1. The real.
2. Imaginary.

At drowning in fresh water there is heavy hypoxia, sharp edema of lungs,

violation of pulmonary circulation of blood, dilution of blood and increase of its
volume, hemolysis of red corpuscles, violation of ionic equilibrium of plasma.
At drowning in salt water the edema of lungs comes quickly, this process
flows during short time, and if not helping to a victim, death comes in 4-5
minutes.
The imaginary drowning has other mechanism – a sudden hit of water in a
trachea leads to a reflex spasm of glottis and water has not time to get to
lungs.
By all types of drowning suffer the functions of cerebrum, then cardiac activity
and breathing are halted.
 PREMEDICAL AID IN CAUSE OF
DROWNING:
After drawing of the victim out from water it is necessary to unzip clothes on
him that hampers breathing.
Expose the mouth with a gag, and in default of such use the finger wrapped
up by a handkerchief, make it back for the last molar and purge the oral cavity
from a silt, sand and water-plants, artificial respiration is conducted. (Before
to begin artificial respiration, the head of the victim is strongly pelted
backwards).
A deliverer must begin artificial ventilation of lungs by a method the mouth to
the mouth at once after getting up of the head of the victim above the surface
of water and continue it at all time to delivery of the victim to bank.
On a rescue ship or on a shore it is prohibited to lose time on deleting of
water from lungs of the victim. Only at the dark blue types of drowning it is
possible to do a brief attempt (during no more than 20 –30 seconds) to
evacuate a liquid from lungs of the drowned man, turning him on a stomach
or lifting and bending through a knee.
 PREMEDICAL AID IN CAUSE OF
DROWNING:
In the case of larynx spasm or hit in
the larynx of strange bodies which are
not added to deleting, conduct
tracheotomy through tracheostomy
cannula sucking suds and carry out
artificial respiration.
If at the victim has not pulse on basic
arteries, and at auscultation cardiac
noises are not heard, quickly proceed
to the indirect massage of heart.
It is possible to transport after
renewal of cardiac beating and
independent breathing of the victim,
but all necessary reanimation
measures must be continued in
transit, especially it is up to active
oxygen therapy by means any vehicle
for inhalation of oxygen.
 Algorithm of grant of
premedical
the aid at drowning:
І. If the victim did not lose consciousness:
the wet clothes are taken off, a body is wiped, enfold in a heat give hot drinks
(tea, coffee);
measures on neutralization of emotional stress;

ІІ. If the victim without consciousness but with a satisfactory pulse and
with the spontaneous breathing:
lay with elevated on 40-50° feet horizontally;
give to breathe a liquid ammonia;
hands, feet, thorax, are ground;
inhalation of oxygen.

ІІІ. The agonal state or clinical death:

release of overhead respiratory tracts from
the strange matters;
conducting of artificial respiration;
support circulation of blood.