Transcript

0:10

And she is the EMT instructor at Dastown High School. Dastown is one of the largest high schools in the State of Louisiana. And she has her bachelor's in kinesiology and health promotion, as well as her master's in exercise science from Louisiana Tech. She's a member of the athletic training advisory committee of the LSBME. She has an incredible knowledge and background and athletic training and experiences at multiple stops at high schools in Louisiana and she is in just an outstanding person.

0:48

So, Blaney, wanna got it pulled up yet,

0:53

It's telling me that I'm not able to share.

0:57

Alright. Let me see if I can work some magic here. So, Lady, I'm gonna take a shot and make you the host, and then you're going to turn it back over to me when you finish.

1:09

Okay.

1:10

We'll try that.

1:17

At work? Alright. I think we got it now. We We're on the end.

1:20

Alright, lady. The floor is yours. Again, if you have any questions, please put them in the q and a, and we'll roll give him the lane and then we'll roll into the next presentation immediately after that. So thank you for us today if you'll put it in full presentation mode or it is there. Okay?

1:39

It's there.

1:40

Thank you.

1:41

Alright. Well, I appreciate this opportunity. Today, we're gonna talk about the airway assessment and management, and we're gonna kind of focus on these issues for athletes. A lot of times as athletic trainers, we don't always have, you know, some of the skills and knowledge that we need to accurately be able to assess these injuries in the athletes, especially when it comes to airway. So we're just gonna talk a little bit about some different things that we can recognize and listen that'll help us.

2:15

Alright. So my disclosure, I have no affiliation with, you know, the financial interest or nonfinancial of the subject matter here or the materials used. So let's get on to our conversation. Some things that we're gonna look at is those presentations of the abnormal airway sounds. We wanna be able to identify those sounds and know the difference between, you know, is this patient or this athlete just having difficult breathing, or are these true sounds that we need to focus on these medical emergencies for?

2:52

We're gonna look at some procedures some manual maneuvers that a lot of us as athletic trainers focus on. You know, we're gonna talk about that head tilt chin lift and that jaw thrust maneuver and the importance of those in using them. Also positioning of our patient, if there is an airway obstruction, we want to make sure that we position our patient appropriately depending on the situation. And then we're gonna talk some about suction devices, a lot of times athletic trainers, don't necessarily use suction devices as much, but we need to have a strong understanding in that so that we can clear the airway if needed and identify, you know, what substances might be there. So first, we look at the causes of our upper airway obstructions.

3:42

A lot of times with athletes, we may see, you know, poor body airway obstructions. We may see fluids or food, but we also have to consider the tongue being an obstruction or teeth teeth are knocked out. Swelling in of the tongue, mouth, and oral fairings, those can also be obstructions because of the amount of swelling that we have going on. With the athletes' thorough fairings or their tongue and mouth areas, tissue damage. Tissue damage can occur with a blow to the throat.

4:16

It can also occur to other things that are gonna cause trauma to that athlete. Epiglottitis is the inflammation of that epiglottis and then infections. I know Caitlin talked a little bit about infections an illnesses earlier, but those are also things we look at with our airway obstructions. And if you look to the right here, you know, we can we can identify if it's the tongue in the back of the throat by listening to some of the sounds that we're gonna talk about further. Tissue damage as well.

4:51

We have specific sounds that we listen for with these athletes and anything that might cause the obstructions to occur to help us identify our evaluation tools. So these sounds that we that I was just talking about, we have strider, rowing, snoring, and gurgling. Strider's gonna be that high pitched sound that you hear. A lot of times, it's gonna occur with inspiration. And a lot of times, we see this as inflammation of the larynx.

5:24

You can also have strider when the tongue becomes an obstruction. If they're laying on their back, We wanna make sure we open that airway because that tone can relax into the back of the throat and cause an obstruction there. Crowing sounds are gonna be very similar to Strider. It is a high pitched kinda crow sound that comes during breathing, but it's a spasm usually cause causing this sound to occur, and it's in that larynx area. The narrowing and opening of the trachea, we can also have some spasms occur there.

6:01

The snoring respirations partial obstructions of the airway, you see this as well with the tongue and other tissues that may become inflamed in the pharynx. And then we have gurgling. Gurgling is that sound that indicates fluids. So if we have fluid or vomiting, other secretions that are in our fleet's throat, and we hear the gurgling sound when they're struggling with that patent airway, we wanna make sure that we suction it. We wanna make sure that we clear those fluids accurately and make sure that we can open that airway.

6:36

Because ultimately, Having an open airway is the most important part of our assessment when it comes to an athlete that may be struggling with the airways. So some different procedures that we use with our airway assessment is the airway patent. Is the airway open? Is it clear? Can we hear the breathing sounds moving back and forth?

7:02

We wanna make sure that we have adequate breathing. You know, a lot of times we talk about what does adequate breathing really look like. We wanna make sure that we have equal rise and fall of the chest. We wanna make sure that we have between 12:20 breaths per minute with our athletes. And I know it's hard when you're evaluating an athlete to sit there and count their breaths.

7:25

But at the same time, we wanna make sure that the rate is adequate along with the quality of breaths that they're getting. Our position of the patient, you know, they may be in the tripod position they may be bent over trying to breathe and catch their breath. That would be their position of comfort that they're in. But we also wanna consider if that patient is lying on the ground or if they're unresponsive. You may have a patient who is supined.

7:53

We wanna make sure that, again, with that assessment that we see, is this airway open? Are they breathing adequately and are they moving air? Otherwise, we wanna make sure we open it. And then we look at skin presentation. We're looking for paler skin or cyanosis.

8:11

Is that athlete turning pale due to the lack of oxygen that they're getting? Are they turning blue? What, you know, what type of skin presentation do they have? So these are some of the things that we wanna make sure when we're assessing the airway that we are looking at in order to determine the emergency situation of what's what's next and what's to come. When we open that airway, we've all as athlete trainers learned.

8:42

You open the airway with a head tilt chin lift or jaw thrust maneuver. This is just kinda to help remind you. Our head tilt, chin lift, we use with this when there's no spinal injury suspected. The biggest thing with the head tilt trim lift is making sure that you avoid overextension. If you overextend that neck, then you're actually closing off the airway because you're putting more pressure on that trachea.

9:09

So you wanna make sure that when you extend the neck back to do a head tilt chin lift that you're not overextending. The jaw thrust maneuver That's something that we would use with the spinal injury being suspected. We wanna make sure that we have in line stabilization on our athlete before we try to perform a jaw thrust maneuver. The key here is to have as little movement as possible. So we wanna make sure that we maintain that neutral head position, and we keep it in line, and then stabilize as we're opening with a jaw thrust.

9:51

The positioning of our patient or our athlete. Well, when we have no suspected spinal injury, we would like to be able to put them in the recovery position. The reason we wanna put them in a recovery position is because if they're lying on their side and they have fluids or anything from the mouth, we can make sure that we get rid of this. It helps to drain those fluids. If you are positioning the patient In order to provide ventilation, then we're gonna have that patient in a supine position if no fluids are present.

10:26

In order to have the adequate ventilation, they have to be supine. So if they're prone, we may have to low roll them in order to get them to that position. If we suspect that there are fluids in the mouth, we're gonna put them on the side if they have no suspected spinal injury. If they do have a spinal injury or we suspect that there is 1, then we maintain that in line stabilization we give spinal motion restriction to our athlete, and then we wanna make sure that we open the airway and if we need to suction then will you suction any fluids that may be there to clear that air away? So talking about suctioning, suctioning is kind of one thing that we really need to understand the technique.

11:13

We can cause further damage if we don't. So we wanna make sure that we set up our device correctly. A lot of times, we'll have a manual device, analog electronic device as their options. But as athletic trainers, typically, you're gonna have the manual device that would be the most convenient for you to access. And we'll show you some of those in just a few minutes.

11:36

We're gonna measure the catheter and insert the catheter into the mouth where the fluids would be, and make sure that you can still see the tip of the catheter. Then you're gonna suction as you remove the catheter out. Again, it's important to make sure you can see the tip because you don't wanna have any kind of damage to the the pharynx. In the backside of the throat, and you don't wanna cause any kind of vital issues such as bradycardia or anything like that to occur. You suction as you remove the catheter.

12:12

Do not suction more than 15 seconds at a time. And if you have a pediatric athlete that you're working with, then you wanna limit that time to about 5 seconds of suctioning to occur. And then obviously, we're going to make sure that we clean the catheter once we're done and clear out any of those fluids that are in the catheter. Since the special considerations for suctioning, if you can roll the patient onto their side in no recovery position, then we wanna roll them to their side maintaining their head position. If they have a spinal injury, we would not roll them to this side.

12:52

But if there is no suspected spinal injury, then we can roll the the athlete or the patient onto their side. Manually sweep the mouth if there's too much reception, you may have to actually reach into the mouth and sweep some of the fluids to the side. You're gonna have about 15 seconds of suction time. If it's frothy secretions, then you may have to provide 2 minutes of positive pressure ventilations via the the bag valve mask and then repeat suctioning for that athlete. You're gonna monitor vital steering suctioning.

13:28

If that heart rate drops, be prepared to administer oxygen. And be ready for positive pressure ventilations because it is possible that you'll need a high flow of oxygen and positive pressure ventilations. Now with these patients that we're going to suction, we're looking more at a nonresponsive patient because our unresponsive patients aren't going to be able to turnover on their own or actually expel the fluids like we would want them to. So these patients that were suctioning or athletes that were suctioning We're looking at them as the unresponsive patient that we need to suction and assist to open that airway. Some types of devices.

14:14

I mentioned the manual suction and the electronic suction devices. Manual suction devices are going to be handheld. They're portable. They're easy to carry a move. So as athletic trainers, we have these in our kits that we carry with our airway management kits.

14:34

It's it's very similar to this one here where there's a couple different versions out there as well. But each one of them will have a catheter that's connected to it that you can change out either the rigid catheter or you can utilize a soft catheter as well. And then the electronic devices, they are gonna pull a higher power of suction. So if you have access to one, it is great to utilize, but the manual suction device works just as well and it's very easy and very convenient to use. So talking about those rigid catheters and the soft catheter.

15:18

The rigid catheter is what we're going to use when it comes to the mouth and the oral bearings. Those catheters, we're going to to put the device in as far as you can actually see the tip of the catheter, and then you wanna make sure that you are suctioning as you remove it. Again, it's about 15 seconds of suction, you don't want to do any more than that. But you also want to make sure that you measure it correctly. So making sure that you can still see that tip of that catheter is going to allow you to know that you have not inserted it too far into the back of the throat.

15:56

The salt catheter device is more of a tube type device. So I'm a go back a slide. If you look there on the side where the manual suction is, that small tube would be the salt catheter that I am talking about. So the salt catheter can be used both for the nose or or nasopharynx, and then the soft catheter can also be used by the mouth and over aarynx. For the soft catheter, you wanna measure it very similar to what you do for the OPA and the NPA that they were talking about earlier.

16:35

The SOP catheters for the nose, you're gonna measure from the tip of the nose to the earlobe, and make sure that you have the correct size as far as inserting the catheter into the nose area. And then as far as the mouth goes, you're going to measure it from the corner of the mouth to the tip of the earlobe. So it's very similar to both of those, the NPA and the OPA. Sorry. Okay.

17:09

We're gonna look at a couple scenarios. I want you to kind of play along with me here on this, and we're gonna look at some questions and see what type of things we can think of and come up with for these questions. Alright. If you're gonna answer, I want you to answer in the q and a area, and we'll make sure that we go through those questions. Uh-huh.

17:33

Sorry. Go back. Alright. You're the athletic trainer for a high school soccer team. During our practice session, one of our players is a sixteen year old male who suddenly collapses on the field.

17:46

They appear to be choking. They are conscious, but in distress, clutching their throat, and you suspect an airway obstruction. So our first question to look at here is how would you approach this athlete safely in emergency situation?

18:09

Hey, Langley. Let's let's let's give them to put it in a chat. That way, it'll be a little bit better flow. So Okay. If you answer her questions according to how she asked them, she's asking you to respond.

18:22

So type in a chat, how question number 1.

18:33

Does anybody have any thoughts on approaching this athlete in this situation? So is this an athlete that if we oh, hold on. Let me check. Okay? We're gonna look at field conditions.

19:05

So we wanna make sure that we approach this athlete in a stable position and make sure that the airway is open first. We're looking to assess that airway as we approach. That is correct. What are the initial steps that we would take to assess the severity of an airway obstruction? So what types of things can we look at to understand severity of this airway obstruction.

19:37

K. Look, listen and feel. Check for universal signs of choking. What techniques and maneuvers do you think that we can employ to clear this athlete's airway or obstruction? And what order do you think we would do it?

20:12

So after we've identified the breathing sounds. Maybe the sounds are are there's a strider or you have a snoring sound that you hear. With this obstruction. What technique could we do or maneuver can we do for snoring type sounds? With this athlete if they're still lying on the field.

20:54

We can activate EMS, make sure EMS is on the way. Try and get them to call for and calm their breathing, be more active to the process prior to jumping in. What if our athlete is lying on the ground and their responsiveness is changing on us? They're still conscious, but they're kind of moving in and out of responsiveness. Sorry.

21:34

They may need a bag valve mask. They may need artificial ventilation. I'm like, maneuver would be good if there's something stuck in the airway. I'm trying to get them to talk. If they have those snoring respiration sounds, and they're lying on the ground and they're trying they're kinda in and out of consciousness.

21:58

We may need to perform a jaw thrust maneuver if this spinal injury is not injured. If there is a spinal injury, we may have to do a head tilt chin lift. With that snoring respiration, we could have the tongue that has developed some swelling that is causing those respirations to sound off for us. So what equipment, if any, should we have on hand, to assist in this situation? What types of equipment do you think that we need to use for this type of situation?

22:44

We may need a OPA or NPA. Depending on their level of consciousness or responsiveness, we may have to suction if we see fluids We need our bag by mask available for sure. Oxygen. If we're gonna administrate oxygen, we need to make sure that we have oxygen. And a d.

23:21

Sorry. I keep putting the wrong button on my computer. Communication to the EMS. When we've called EMS, we want to make sure that we are communicating the condition of our athlete. Make sure that they know what they're walking into as soon as they arrive.

23:39

So after we've successfully managed the airway obstruction, and the patient is now needing follow-up care. What types of things might be necessary? In evaluation and follow-up care for this athlete. Does this athlete still need to be transported? Yes.

24:38

K. If you have cleared the airway obstruction of your athlete, and they're still, you know, trying to recover a little bit. We need to make sure that they still are transported. It could be that they weren't choking on a food item. It could be inflammation that has occurred causing this to happen.

24:57

It could be an infection, again, back to the first few slides where we were talking about infection being a problem, the tongue, and inflammation that can occur in the trachea and in the larynx. We wanna make sure that we are checking for those things. If they hit their head, or had some sort of head to head contact. We wanna make sure that we check for signs of concussion as well. It could be something that's triggered there that's causing this difficulty breathing to occur.

25:32

We're gonna look at one more scenario here, but we're gonna see kinda what our thoughts are with this one. We're at a college basketball game. Our twenty year old female player who has suddenly started to exhibit signs of respiratory distress. We have gassing for air, audible strider, and they're unable to speak. Everyone is concerned.

25:60

As an athletic trainer, how do we quickly assess this athlete's airway? And their breathing with the crowded high pressure sports environment that we are in. If everyone is watching us, how do we quickly assess this airway. Is this something that as athletic trainers were already kind of watching? At work.

26:48

So we can listen to those lung sounds. We see what's going on checking the mouth for abnormalities. What could be a potential cause for this respiratory distress? If they're in a game and if signs of respiratory distress occur, They began gasping. Could potentially be asthma.

27:25

We hear strider. They're not able to speak. Hey. Looking for a mouth guard, there may be an update in their mouth. That has caused this issue to occur.

27:45

We also have inflammation in the upper airway. To the upper airway, we're focused on that bearings, larynx, and there into the trachea. So we could have some inflammation going on in that upper air airway that's giving us that sound of strider that occurs. So one thing we want to remember is the difference between the upper airway breathing sounds and inadequate sounds, and also the lower airway inadequate sounds. A lot of times when the bronchials are inflamed or when you start to have asthma, we have the wheezing sounds that occur, and those are gonna be in the lower airway.

28:31

But if we have strider or crowing, gurgling those types of sounds, that's gonna be more of an upper airway obstruction. So that helps us to identify the difference of where these inflammation issues may be coming from. So back to our twenty year old female, what immediate actions should we take to stabilize this airway and breathing? We may have to reposition this person. We wanna get them in a comfortable position.

29:23

Where they're able to move that air in and out and have proper respiration. Taking deep breaths, slowing your breathing down, you know, coaching our athlete through this breathing. Is something that we all wanna make sure that we do to slow them down. If the athlete's condition worsens or doesn't improve with the initial interventions, What would our plan of care be? And and would we wanna call for additional medical assistance?

30:01

Initially, you're right. We wanna move them away from the crowd. We wanna make sure that we get them into an environment where it's a lot calmer environment, not too many people are standing over them. And then are we going to call for additional backup with this 1? We're gonna call EMS on this athlete.

30:49

You give them time. If they do not improve over a reasonable amount of time, then we want to make sure that we call EMS. Otherwise, if if they improve pretty quickly, then we wanna make sure that we ensure that ongoing care or address any underlying issues that may have caused this difficulty for this athlete here. So kind of to pull this all together, you know, we wanna make sure with airway assessment, athletic trainers have to have a full understanding of how to assess the airway. We also wanna make sure that we understand how to manage it.

31:30

We looked at suctioning devices and some things that can be used when you have to activate emergency care. Section devices are going to be utilized for those unresponsive athletes who have fluids of some sort or objects within their throat that you need to make sure that you clear the airway for. And then opening that airway, making sure that the airway is open We have to get at that proper rate and quality of breathing. Again, you want about 12 to 20 breaths per minute. So if they're not adequately breathing, we may need to provide that supplemental oxygen, use positive pressure ventilations for our athletes as well.

32:10

And overall, we have to make sure that we manage this correctly and get them the additional care they may need in a timely manner. Ronnie, I think you're muted still.

32:30

There we go. Thank you, Lainie, so much. We will now move into q and a. We got one question that I'm anxious to get your opinion on, which is the popular plungers advertised for obstruction in children. What do you think?

32:47

I mean, plungers aren't really in our scope of what we're gonna do as athletic trainers. At the EMT level as well, you know, they would rather utilize the suction device to clear everything out. That that's my opinion. My opinion is that the suction device is what I'm gonna go to first when I wanna clear an obstruction in a child.

33:09

Yeah. I like I like that because you gotta go back to your scope and standard of care whether you Right. Whether you believe in it or not, there's a lot of home remedies and devices and things out there that my grandmother would do for me, but Mhmm. Doesn't necessarily mean that I would do for My patience. Excellent.

33:28

So my question and y'all please chime in here in the q and a section, but So Doctor Holkman presented to OPNP and Augeo, and then Caitlin came back in as well and and Mark did with the BBM. I'm about to talk about oxygen. And so you brought in suctioning. So where do you store all this? Like, we we've accumulated.

33:52

You asked about equipment, and and where where do you put all of this?

33:57

We have an airway management kit that we utilize. It has everything that's needed when it comes to airway management. It's one bag. We have our oxygen there with our regulators. Our nonre breathe their masks, our bag valve mask, it fits the OPAs and NPAs in the side pockets, and, also, you can set your suction device if you have manual suction devices right there in one area.

34:25

That everybody knows, this is our airway management kit, and that's what it's used for.

34:30

Got you. Yeah. Yeah. It is. It goes where with you.

34:35

Where where does it go? Where where is it accessible?

34:38

It it's accessible everywhere. It We bring it on our sidelines for games, whether it's football, basketball, soccer, baseball, softball, everything. This is one of those kits that, you know, along with our first aid supplies and our Splunting. Those are in their bag by themselves. This is bag goes along with us.

35:02

Yeah. Harrison asked some question about your top rated suction advice. What what what would you what what do you buy? What do you use in

35:11

Well, it all it all varies. It varies what you have access to. You know, we like to use manual suction devices that we're seeing here in the slides, but there's all kinds of different ones. Whatever you have that's most accessible to you, that's what I would say is what you're gonna be able to utilize. Feel it, practice it, and get a device that you're comfortable using.

35:38

Excellent. Alright. Any other questions? What's the name of your airway management kit cost and how much does it cost? Your airway management kit.

35:48

What do you think? What's the price tag on putting all that together?

35:54

Well I

35:54

know that answer because I'm ball. I'm ball. I'm ball. Yeah. Yeah.

35:59

Gosh. Pre COVID after COVID, you know, you're looking probably around $500 for the kids now. Pre pre COVID about 350. Right. I know.

36:08

Right now, what's in our kit is probably about $500 total in that one bag.

36:17

Well, I know. I can't imagine covering events without it. I get nervous. When I don't have those resources because my scope changes and because just the ability is something as simple as a suction device and how how practical and useful and the odds of somebody in respiratory distress, you know, throwing up on you or having fluids is pretty hot. Right.

36:42

And you're at the mercy of a glove finger and hopefully, you know, trying to get somebody on their side effectively with help. Because Right. You can't do it by yourself. So having a suction device is like like fundamental. Yes.

37:01

Excellent. Well, Amy, no more questions, last comments you'd like to make as we close out today.

37:10

You know, if you have any questions, you can email me. It's there on the screen. The biggest thing to do is make sure you practice and under to hand your assessments and your airway management. Make sure that you have access to the equipment that you need And if you don't have access to the equipment that you need, have a plan. Have an emergency plan of what you're going to do if something does happen.

37:37

Excellent. Well, speaker number 3 out of 16 is down.