Approaching a Victim and Opening an Airway

John:

All right. Whenever we are approaching victims we should always do this
at an arms distance. If you remember the old training where you approach
patients, first or all me and my buddy should do a good size up. Once we
do that size up we are also making sure that were wearing the proper
protective clothing, gloves, goggles, mask, helmet, boots. We work
together and we approach patients at an arms distance and we give them a
good shake and a shout. Hey how ya doing. Why do you think it's a good
idea to approach patients at an arms distance and give them a shake and
a shout? What if this was the worst event I've ever been through and I
decide that what I'm going to do is lay down and rest, and then you're
going to come jump on top of me. What is a natural reaction for me when
you come and start pushing all over me? Strike out. So maybe what we
should do is we should always approach patients at an arms distance and
give then a shake and a shout. I'm not saying take the boot to them,
what I am saying is to give the just a nice gentle shake and a shout.
Now the patient doesn't respond, in fact Cory unconscious. So what were
going to do is were going to make sure that first of all this patient
has the ability to breath. Patients breathe through the airway. Help me
define in a very simplistic manner what the airway is. It is the
passageway that air follows, starts at the mouth goes down to the lungs.
What kind of patient is most at risk for having an airway problem? Ok,
one who's yelling at you? No. Maybe the unconscious. Why? There is one
muscle that will end up causing the trouble. Which one is it? The
tongue. The tongue falls against the back of the throat blocking the
airway. How many of you have ever gone to a rescue response or a medical
response where it was said to you that they were swallowing their
tongue? Yes or no? How many of you have seen people who have tried to
fix that, in various ways? Is there a understanding out there in the
general population that you can swallow your tongue? Yes there is. There
is a misconception and we can do a little bit of education here. Can you
swallow your tongue? Not unless you slice it up, put it on rye and down
it goes, no you cannot. But what it can do is it can block the airway.
Now, remember what we used to do before, we used to put a hand on the
forehead and a hand underneath the neck and then you would tilt the head
back to try to lift. Why did that work? Or why did that work? Because
the tongue attaches to the jaw. When you push the jaw upward it lifts
the tongue up off the back of the throat. Maybe we could get somebody
else to help us hold him in that position. One time I , the whole idea
is weather your trying to tell me is what you want to do is elevate
those shoulders to keep that head in that hyper flexed position. I went
to a bomb incident one time where I watched a fellow who was taking care
of a patient he rolled the patient up on his side and he took a broken
2x4 and he shoved down underneath the shoulders. When he rolled the
shoulders back it ended up...Well first of all, the first problem was
that hurt him because is was a broken 2x4 and he shoved it right into
him. The second thing that he ended up doing is when you want to hyper
extend that head if you jack up one shoulder where does the rest of the
head go? Off to the other side and it really didn't do that good of a
job. You can do a lot of different things for example, using shoes,
using debris, using someone else to help you, you can do a lot of
different things to help you keep that airway in that open position. And
by keeping that airway in the open position look, listen and feel, you
can access very quickly if the patient is breathing and what going to be
important later on is how fast the patient is breathing. All right,
that's pretty easy isn't it. Yes, Yes it is. Lori come help me for a
second please. Lori lets just walk through this. Because what were going
to do in our CERT classes is were going to make sure that everybody gets
good hands on training, which means a lot of repetition. Were going to
do a lot of things in threes. We'll go, we'll walk through it and we'll
speed things up. But first of all lets make sure that you're wearing the
proper protective clothing, things like,

Students:

Gloves, goggles, mask, helmet, boots.

John:

Lets first of all me and my buddy will always do a good size up and what
I want you to do, were just going to walk through this real slow, I'll
help. I want you to approach Cory, who's unconscious, and get at an arms
distance and I want you to give him a shake and a shout.

Lori:

Hey, are you Ok?

John:

Now he does not respond to us so what I want to do is I want you to open
his airway, Ok. I want you to put a hand on the forehead, couple fingers
underneath the chin, don't let go of that hand, put your ear over his
mouth, look down. Cory take a deep breath. And I want you to tell me
what he had for lunch. Ok. That's pretty easy isn't it. Ok. And remember
we would always want to leave him in this position so we would lift up
the shoulders we would get somebody else to come over and help. This is
fairly easy. Let's get back up a little bit. And lets do it again. We've
got our gloves, goggles, mask, helmet, boots. Now, when you approach
this time, what I want you to do is I want you to give him a shake and I
want you to say pretty loud, Hey are you all right.

Lori:

HEY, ARE YOU OK?

John:

Doesn't respond. Open the airway.

Take a big breath Cory.

Good, I want you to back up again. Now I'm not going to help you at all.
Me and my buddy will do a good size up. What are we wearing?

Students:

Gloves, goggles, mask, helmet, boots.

John:

Ok, I want you to speed up a little bit now.

Lori:

Hey, are you Ok?

John:

Everybody gets the chance to do it three times, stay there till I tell
you to move. Good. Everybody gets a chance to do it three times. How
about a hand for our volunteer and how about a hand for Cory.