You arrive at the residence and find the gentleman unconscious. A family member states he was able to assist him to the ground. The victim is breathing shallowly. He is observed to be obese with a short neck.
What tools do you pull out of your bag, and why?
- Portable Suction
The first priority in any respiratory emergency is to clear the airway. A head tilt, chin lift maneuver is used to open the airway. You use your portable suction device to remove some mucus that has pooled in the oropharynx. No vomit or blood is seen.
- Pulse Oximeter
You quickly slip a pulse oximeter onto his index finger to get a baseline oxygen saturation. You note that his lips look pale and his hands are cool and clammy. The oximeter reads 90%.
- Nasopharyngeal (NPA) and Oropharyngeal airway (OPA)
A patent airway needs to be maintained, so you reach for your airway adjuncts. You determine that your victim does not have a gag reflex and select an OPA. You open the victim’s mouth and insert the OPA upside down, rotating it 180 degrees when it reaches the back of the mouth. The OPA is advanced until the flange reaches the victim’s front teeth. Oxygen is delivered to the victim via non-rebreather mask.
- Bag-Valve Mask
At this time, you note that the victim has stopped breathing.
- Endotracheal Tube (ETT)
- Endotracheal Tube Introducer (ETI)
Since the victim is obese, he is placed in a “stacking” position, using some folded towels under his shoulders and head to raise the tip of the chin just higher than the chest. With the laryngoscope, you try and visualize the vocal cords. Suction is used again to clear the airway.
The airway is hard to visualize, so you insert an ETI in the middle of the larynx past the base of the epiglottis. An 8.0 ETT is inserted over the ETI, and the ETI is removed. Ventilations are resumed using the bag and oxygen, but the victim’s chest wall is not moving. Oxygen saturation is dropping.
- End tidal Carbon Dioxide monitor (ETCO2)
- Supraglottic Airway Device (SAD)