to cough. If the patient is unable to cough, begin totreat the patient as if this were a complete obstruction.(This also applies to patients who are cyanotic.)Complete Airway ObstructionConscious patients will attempt to speak but willbe unable to do so. Nor will they be able to cough.Usually, patients will display the universal distresssignal for choking by clutching their neck. Theunconscious patient with a complete airwayobstruction exhibits none of the usual signs ofbreathing: rise and fall of the chest and air exchangethrough the nose and/or mouth. A complete blockageis also indicated if a correctly executed attempt toperform artificial ventilation fails to instill air into thelungs.Opening the AirwayMany problems of airway obstruction, particularlythose caused by the tongue, can be corrected simply byrepositioning the head and neck. If repositioning doesnot alleviate the problem, more aggressive measuresmust be taken.POSITIONING THE PATIENT.When apatient is unresponsive, you must determine if he isbreathing. This assessment requires the patient to bepositioned properly with the airway opened.Before repositioning patients, it is imperative thatyou remember to check them for possible spinalinjuries. If there is no time to immobilize these injuriesand the airway cannot be opened with the victim in thepresent position, then great care must be taken whenrepositioning. The head, neck, and back must bemoved as a single unit. To do this, adhere to thefollowing four steps (see figure 4-2).Step 1—Kneel to the side of the victim in line withthe victim’s shoulders, but far enough away so that thevictim’s body will not touch yours when it is rolledtoward you. Straighten the victim’s legs, gently butquickly. Then move the victim’s closer arm along thefloor until it reaches straight out past the head.Step 2—Support the back of the victim’s head withone hand while you reach over with the other hand tograsp under the distant armpit.Step 3—Pull the patient toward you while at thesame time keeping the head and neck in a naturalstraight line with the back. Resting the head on theextended arm will help you in this critical task.Step 4—Roll the patient onto his back andreposition the extended arm.Once the patient is supine with the arms alongsidethe body, you should position yourself at the patient’sside. By positioning yourself at the patient’s side, youcan more easily assess whether the patient is breathing.If the patient is not breathing, you are alreadypositioned to perform artificial respirations (alsoreferred to as rescue breathing) and chest com-pressions.Either one of two maneuvers—the head tilt-chinlift maneuver or the jaw-thrust maneuver—may beused to open an obstructed airway. When performingthese maneuvers, you may discover foreign material orvomitus in the mouth that needs to be removed. Do notspend very much time to perform this task. Liquids orsemiliquids should be wiped out with the index andmiddle finger covered by a piece of cloth. Solidmaterial should be extracted with a hooked indexfinger.HEAD TILT-CHIN LIFT MANEUVER.—Thehead tilt-chin lift maneuver is the primary method usedto open the airway. To perform the head tilt-chin liftmaneuver, place one of your hands on the patient’sforehead and apply gentle, firm, backward pressureusing the palm of your hand. Place the fingers of theother hand under the bony part of the chin. Lift the chinforward and support the jaw, helping to tilt the headback. See figure 4-3. This maneuver will lift thepatient’s tongue away from the back of the throat andprovide an adequate airway.PRECAUTIONS:When performing thehead tilt-chin lift maneuver, do not press toodeeply into the soft tissue under the chin.Undue pressure in this location may obstructthe airway. In addition, make sure the mouth iskept open so exhalation and inhalation are nothindered.JAW-THRUST MANEUVER.—The jaw-thrustmaneuver is considered an alternate method foropening the airway. This maneuver is accomplished bykneeling near the top of the victim’s head, grasping theangles of the patient’s lower jaw, and lifting with bothhands, one on each side. This will displace themandible (jawbone) forward while tilting the headbackward. Figure 4-4 illustrates the jaw-thrustmaneuver. If the lips close, retract the lower lip withyour thumb. If mouth-to-mouth breathing is necessary,close the nostrils by placing your cheek tightly againstthem.4-12
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