The Safety pin airway – Iraqi style! (Sweet unibrow dude!)
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Treating a trauma casualty was briefly mentioned in Andrew R.’s First Aid Kit article, and we’ll make sure to post more thorough discussions here in the future on how to treat all things trauma.
In Andrew’s article he introduced EABC (exsanguinations, airway, breathing, circulation), and briefly discussed treating life-threatening bleeding. The next step in the trauma assessment is ensuring the patient has a patent airway.
Unless the airway is blocked due to a foreign object (debris, broken teeth etc), the main cause of an airway blockage is the tongue relaxing and blocking the airway. So opening an airway simply involves removing any object that is blocking the airway and making sure the tongue is out of the way.
Oral pharyngeal airways are designed to pull the tongue up and towards the front of the mouth, ensuring it doesn’t slip back and obstruct the airway. The downside with oral pharyngeal airways is that they have to be sized correctly to the patient, so you have to carry a half-dozen or so. In addition, if the patient should regain consciousness or is semi-conscious, they can trigger the gag reflex.
Oral Pharyngeal Airway
And while they are fairly light, relatively inexpensive and simple to use, they take up a lot of precious space, and should, in my opinion, be reserved for an ambulance or in a dedicated medical or squad trauma bag.
Nasal Pharyngeal Airway
The other standard airway is the nasal pharyngeal airway, which, while should be sized in the ideal world, you can get away with only having one in your kit (preferably sized for you), and they don’t trigger the gag reflex. You should absolutely have one of these in your FAK (First Aid Kit) and know how to use it. I’ll dedicate a future article to their use because of how important they are.
But sticking with the theme of ditch medicine, if you don’t have a well-thought out FAK (so no purpose built airway) on you and you need to secure the airway of a casualty, here’s how you can do it. Most off-the-shelf first aid kits come with a triangular bandage (cravat) in them.
The triangular bandage is a piece of thin cloth that is triangular shaped and typically comes packaged in a plastic bag with 2 safety pins. It has many uses including making a sling or sling and swath (if you have two) for a broken arm or some other arm/shoulder injury that you want to immobilize, as a hasty tourniquet, or to tie splints to broken limbs.
Cravat - handy for splints and airways
You can take one of the safety pins that come with a triangular bandage and use it to pin the tongue to the lower lip. This will pull the tongue forward and secure it from blocking the airway.
Obviously, this isn’t the preferred method, and you’ll have to be careful that the bleeding from the now pierced tongue doesn’t obstruct the airway (a gauze pad should do the trick). But it will free up your hands to take care of any other tasks that you need to accomplish.
Replace the safety pin with a stud and you’ll have given a perfectly cool tongue piercing. If you’ve got a buddy who snores, pinning his tongue to his lip will help solve that too.
I will say that the safety pins that come with the triangular bandage are about the perfect size for someone with the hands of a 5 year old girl, so I replace them with some bigger ones. But safety pins are pretty handy things to have around, so I always keep a couple of extras in my kit anyway.
~John B Cheif Medical and S&R Correspondent
John B has been an EMT for 18 years and is currently a Field Team Leader for a Search and Rescue Team, he also holds a Master's degree in Neuroscience.