LIFE-THREATENING PROBLEMS - Medicine for Mountaineering and Other Wilderness Activities - page 20

Figure 3-3. Position of the tongue and epiglottis in an unconscious person with the head and neck ex-
tended to relieve airway obstruction
Airway
If an ill or injured person can talk normally, the airway is open and breathing is normal. If
the person is not breathing, the cause may be obstruction of the airway.
Ifapersonisunresponsive,breathingshouldbecheckedfirst.Anindividualwhoisface
down should be turned face up. If a back or neck injury may be present, the person should
be logrolled while protecting the back ( Chapter 8: Head and Neck Injuries ) . In the field,
breathing can be detected by looking, listening, and feeling: looking for respiratory efforts,
listening for air movement, and feeling whether air is moving in and out. If the chest rises
and falls and air is moving, then the person is breathing. If the person is not breathing, the
airway should be opened.
The most common cause of airway obstruction in an unconscious person is the tongue.
When an individual is unconscious, the muscles of the tongue relax and the tongue falls
back in the throat, blocking the airway. If the person has not sustained trauma and no neck
injuryissuspected,theairwaycanbeopenedbytiltingtheheadbackslightlyandperform-
ingajawthrustbyplacingthefingersattheanglesoftheperson'sjawsandpullingforward
( Fig.3-3 ) .Alternatively,afingerorthumbcanbehookedbehindtheteeth ofthelowerjaw
and the jaw pulled forward. If the possibility of a neck injury exists, the airway should be
opened using a jaw thrust while the neck is stabilized in a neutral position ( Fig. 3-4 ) .
If these maneuvers do not open the airway, the rescuer should look in the mouth for for-
eign material, usually vomit, and remove it by sweeping two gloved fingers through the
mouth or by using a device that provides suction, if available. If the tongue is the cause
of the obstruction in an unconscious person and not enough rescuers are available to keep
holding the airway open, an oral or nasal airway can be inserted ( Fig. 3-5 ). If no other
equipment is available, a large safety pin can be placed through the tip of the tongue and
secured to the lower lip, chest, or clothing to keep the tongue from falling back and ob-
structing the airway.
Advanced airway management is beyond the scope of this chapter, but members of wil-
dernessexpeditionswithappropriatetrainingmayuseotherdevices,suchasaCombitube®