(e) When the tip of the airway reaches the back of the tongue past the
soft palate, rotate the airway 180 degrees so the tip of the airway points down toward
Advance the airway until the flange rests on the casualty's lips.
(3) If the casualty has an intact gag reflex but can still not protect his airway,
insert a nasopharyngeal airway.
(a) Ensure the airway is the correct size by measuring the diameter of
the airway with the patient's fifth finger (pinky) and the correct length by measuring the
airway from the corner of the patient's nostril to the tip of the ear.
(b) Lubricate the airway.
(c) Insert the airway in to the patient's right nostril with the bevel
towards the septum. This is anatomically the larger nostril in most people, and the
curve of the airway is designed to be inserted in this side. Insert the airway by pushing
it towards the back of the patient's head until the flange rests on the casualty's nare.
ADMINISTER TWO BREATHS
If the unconscious casualty is not breathing, you will need to perform rescue
breathing. Rescue breathing procedures are also called "ventilating the casualty."
Ventilation simply means that you are supplying the casualty's lungs with fresh air.
Even though the air comes from your lungs, it still contains plenty of oxygen. Room air
contains about 20 percent oxygen; we use about 4 percent of this leaving 16 percent
oxygen available to the patient when mouth-to-mouth rescue breathing is conducted.
The mouth-to-mouth technique of rescue breathing is normally used. An alternate
technique, the mouth-to-nose method, is used when the casualty has a serious mouth
or jaw injury, when the casualty's mouth cannot be opened, or when you are unable to
achieve a tight seal around the casualty's mouth. Check for the presence of a stoma
(an artificially-created opening in the neck and trachea). A stoma allows air exchange
when the casualty's upper airway is blocked due to surgery or a medical condition such
as cancer. If a stoma is present, perform mouth-to-stoma rescue breathing. Cover the
patient's mouth and nose when conducting mouth-to-stoma breathing to make sure the
air does not escape through this route instead of entering the lungs. As you administer
the two ventilations, observe the casualty's chest out of the corner of your eye to see if
the chest rises and falls. It should take about one second to blow a breath into the
casualty's lungs. Allow time between breaths for the chest to fall and the casualty to
exhale. Avoid over inflation of the lungs, which can cause complications, including
gastric distention, and can also increase the intra-thoracic pressure, making it difficult
for blood to return to the fill the heart.