jaw thrust

[reaper]

Ahh, come on Sky, I thought the were just creating new ways to do things!!

 

[rechargeable]

Okay, so despite all this, I still don't seem to have an answer.

What does a correctly executed jaw thrust feel like (if anything beyond seeing/hearing/feeling an open airway), and once done, does it stay open on its own? So far I'm gathering that it doesn't feel like much of anything other than seeing the jaw DISPLACE and witnessing an open airway, and that it does not stay open on its own. This implies that an additional EMT is then needed just to maintain the jaw thrust. Is that correct?

I agree entirely about your statement about education. The books leave many questions unanswered, and I feel like every time I've ever wanted something clarified in learning about EMS, I get no answer and initiate a thread or conversation exactly like this one.

also, rechargeable, an opa is an airway adjunct, which helps keep the tongue from blocking the airway, but IT DOES NOT MAKE FOR A SECURE AND PATENT AIRWAY... so,no, you can't just put one in and go on to do other things...

and all this talk about dislocating jaws? what happened to DO NO HARM?

WOW! well, triemal04, for all of us involved in the debate about whether or not current education is sufficient, this thread pretty much puts that to bed, don't you think??

 

[RedZone]

Okay, so despite all this, I still don't seem to have an answer.

What does a correctly executed jaw thrust feel like (if anything beyond seeing/hearing/feeling an open airway), and once done, does it stay open on its own? So far I'm gathering that it doesn't feel like much of anything other than seeing the jaw DISPLACE and witnessing an open airway, and that it does not stay open on its own. This implies that an additional EMT is then needed just to maintain the jaw thrust. Is that correct?

I agree entirely about your statement about education. The books leave many questions unanswered, and I feel like every time I've ever wanted something clarified in learning about EMS, I get no answer and initiate a thread or conversation exactly like this one.

Good question. It actually feels pretty natural. No clicking, snapping, or anything like that. I can't think of anybody where the jaw stayed open by itself. As far as needing a 2nd EMT to maintain the thrust.... for what purpose would you want to maintain it? Just because someone's mouth is closed doesn't equate to an obstructed airway. Insert an OPA if necessary, and monitor the airway and in most cases you'll be fine.

If you have to keep the airway open because of serious airway compromise (maybe profuse bleeding from the airway??) then you may have an indication for ALS to do advanced maneuvers if time permits.

As far as the little war that erupted here... I'll just correct two things. I don't do it OFTEN, but I've done it many times. I've worked 13 years in a high volume system. Conscious patients, I've only done it a FEW times (as opposed to quite a few).

Moving on. If a dementia patient, let's say, grabs a foreign object and places it in his mouth.... as long as I feel that there is a moderate risk to his life if I don't take action and he is incapable of providing consent... I have implied consent. To wait for him to choke instead of removing the object... well... that's incompetence. This case, I simply announced to the nurse (we were already at the hospital) that I was holding a jaw thrust so she could remove the object. The patient was in NO distress whatsoever, but couldn't operate his jaw to close his mouth until I released it. And no, he wasn't left lying in bed like some drooling infant with his jaw swinging around. I let go, and everything went back in place.

Also, as someone pointed out, GCS < 8 is the accepted standard for automatic intubation in a TRAUMA patient only. I believe this is the standard put in place by the American Academy of Trauma Surgeons. GCS < 8 in a trauma probably means the patient is going to be in an OR anyway, so intubation is just routine. Just to point out though, GCS < 8 doesn't necessarily mean unconscious.

 

[reaper]

Red, has a very good point. GCS<8 does not me anything, except in trauma pt's. You can have a dementia pt that has a GCS <8, but doesn't need to be intubated.
But, a dementia pt is not competent to make medical decisions for them selves. So yes, you will do what you feel needs to be done.

A jaw thrust is mainly done in trauma pt's, that cannot have a headtilt-chinlift preformed on them. To help keep airway open. I don't know where the foreign object placed in the mouth came from? A jaw thrust is used to lift the tongue out of the way. This is the biggest obstruction you run into.

A jaw thrust can be held by one person, while bagging. If, you have large enough hands to do it. Some women don't, so you need a second person to hold it while you bag them.

This is something you should be showed and practice in class, so you understand how it is done.

 

[RedZone]

Red, has a very good point. GCS<8 does not me anything, except in trauma pt's. You can have a dementia pt that has a GCS <8, but doesn't need to be intubated.
But, a dementia pt is not competent to make medical decisions for them selves. So yes, you will do what you feel needs to be done.

A jaw thrust is mainly done in trauma pt's, that cannot have a headtilt-chinlift preformed on them. To help keep airway open. I don't know where the foreign object placed in the mouth came from? A jaw thrust is used to lift the tongue out of the way. This is the biggest obstruction you run into.

A jaw thrust can be held by one person, while bagging. If, you have large enough hands to do it. Some women don't, so you need a second person to hold it while you bag them.

This is something you should be showed and practice in class, so you understand how it is done.

If I remember right, he grabbed something from the nurse's hands or her pocket and just popped it in his mouth and closed it. It was like an automatic reaction... the first thing I thought of was to jaw thrust (head-tilt chin lift wouldn't have opened his mouth to get at the object, and I'm not shoving my fingers in his mouth if he can bite me). It turned out to be quite effective, and was probably the most humane way to remove the object as opposed to the "barbaric" picture one person is trying to portray.

Improv is probably 65% or more of EMS work.

 

[Ridryder911]

Wow! To make something so simple .. dramatic. MJT is a very simple technique that was taught to common laymen, until the past few years ago. It does not have to be taught by a rescue ranger, nor is a difficult technique.
Something, I still use over and over ..

The main point is the patient muscles has to be relaxed enough to for it to be able to be performed. There is no clicking, special feeling, really nothing to brag about. Your simply moving the relaxed jaw. Their is no magic number in the Glasgow, nor does it have be trauma induced etc.. I use it all the time on patients that has Kyphosis (arthritic fused neck), Grannies that fall in a tub, or with an AMI that has major osteoarthritic history. Practice it on a mannequin (yes, it can be performed on a CPR mannequin) until proficient, then when it you need to perform it, you will be able to.

There is only two patent airways... the normal responsive patient and those that have been ETI. The other(s) are airway adjuncts.. yes, they can assist in maintaining an airway. It is not that difficult.. head tilt (in non-trauma) with an OPA, or NPA is usually sufficient to open the airway, but not to maintain.. without risks of aspiration from vomiting.. etc.

For as removing an object from someones mouth... I guess they no longer teach cross finger technique, where no one can "bite" down.

The other thing is "So what?" They chances are they going to swallow it.. if it is non-digestible, it will come out in the end (pun intended) Kids, make change all the time... If they attempt to aspirate (which is unlikely, if they are awake they will have a "gag reflex"), either they will cough, or they will aspirate it into the lungs.. again, they can retrieve it per bronchoscope..

Again, it is a routine event..

R/r 911

 

[Flight-LP]

Jaw thrust

"The jaw thrust is a technique used on patients with a suspected spinal injury and is used on a supine patient. The practitioner uses their thumbs to physically push the posterior (back) aspects of the mandible upwards - only possible on a patient with a GCS < 8 (although patients with a GCS higher than this should also be maintaining their own patent airway). When the mandible is displaced forward, it pulls the tongue forward and prevents it from occluding (blocking) the entrance to the trachea, helping to ensure a patent (secure) airway.

ILCOR no longer advocates use of the jaw thrust by lay rescuers,[1] even for spinal-injured victims, although health care professionals still maintain the technique for specific applications. Instead, lay rescuers are advised to use the same head-tilt for all victims."
____________________________________________

Perhaps a literature reading update is in order. This was published in the Canadian edition of the Brady EMT text in 2006


And this from a French medical dictionary:

Jaw thrust maneuver

"The jaw thrust maneuver is a method of maintaining an open airway of an unconscious individual. Jaw thrust is used to open the mouth and lift the tongue which obstructs the patency of the airway. It is usually performed by placing on each side of the face, the index and middle fingers at the angle of the mandible. The thumbs are placed on the chin just below the lower lip. As the mouth is opened by exerting downward force on the chin, the index and middle fingers would lift the entire mandible anterior thus moving the base of the tongue out of obstruction."

The above Canadian reference was also published in cooperation with an obscure and little know medical outfit called the AMA.

The jaw thrust maneuver is indeed intended to displace the jaw. Of that there is no doubt. If you were not displacing the jaw, it would not work as it does. Not only is the method falling out of favor with lay responders, it is being phased out as arcane and un-necessary in the medical profession. In any case, you can see above why I was asking who would ever use it on a conscious patient? Unkindly, I will admit, but a patient with a GCS of <8 is generally considered as "gorked." Hence the old medics addage "Less than 8, intubate."

If anyone is doing it often or "regularly" they are doing so un-necessarily and inappropriately. It certainly is not intended as a method to pry open a conscious patient's mouth simply because you want what they have in their mouth to be out of their mouth. If I saw you do it on a conscious patient, I would immediately order you out of service and back to a refresher course.

Allright, I've about had it with you......................

Listen and listen good. Just 6 days ago you are asking us how to blouse your boots and now you are some freakin expert on anything and everything. First off, the jaw thrust is indicated if needed on all pts. conscious or unconscious. 2nd off, it was not designed nor is it appropriate to dislocate someones jaw. Your 'Nam vet friend showed you a technique that was utilized by the military in much different circumstances. 3rd off, perhaps if you took a moment to LISTEN to others, you may actually learn something. Thus far you have argued with several VETERAN medics, VETERAN military operatives, and VETERAN police officers. For an EMT-B to come into our forum and start vomiting diarrhea from the mouth is completely innappropriate and establishes ZERO credibility on your part. Especially when YOU ARE WRONG!

So here's some free advice............

Sit back, enjoy the forum and listen to what others have to say. You may surprised, some of us know what we are talking about.............

And one last thing. Don't pull the Katrina card. Your DMAT team was nothing special down there. IT was just one of MANY organizations that grouped together for a cause.

Pride is one thing, but not to be confused with egotism. Since your good at pulling up definitions, you can get my drift...................

Now your squared away!



























Off to my time-out corner before FF8978 drags me there............................

I hope everyone has a wonderful evening.

 

[Ridryder911]

Atta boy!.. now, breathe deeply and inhale the Xanax spray...

I have to agree from one that has been a member of DMAT for the past 15 yrs.. It is a good organization, that anyone that is medical can participate and join in. .

R/r 911

 

[rgnoon]

Remind me not to find myself with a compromised airway in Illinois.

On a separate note, (I think/hope) We all know that the MJT is not meant to dislocate the jaw, but frankly I'd be concerned about the dislocated jaw further obstructing the airway.

Now how about passing that xanax...its not nice not to share :-D

 

[ffemt8978]

Off to my time-out corner before FF8978 drags me there............................

I hope everyone has a wonderful evening.

No need for me to do that if you're already there.

 

[jrm818]

Just in case there's any doubt remaining about what a modified jaw thrust is...

heres a movie of a guy doing it to another completely concious, uninjured guy. There is no trauma as a result of the jaw thrust. The joint of the jaw is not dislocated....rather the jaw is moved ("displaced"). American Heritage is a bad source for medical definitions anywyas.

P.S. it's the first hit on google for "jaw thrust"

 

[Gbro]

When I was just getting started in 1980, The EMT's on my service talked about dislocating the jaw in a cervical spine injury.
Then came the EOA,
http://www.med-worldwide.com/product1607.html

This airway has been on the rig ever since.

Remember back in those day we were taught some very impractical techniques.
Like Cervical traction! 18Lbs of traction that wasn't to be let up on until the Multi Trauma dressing/Kling was in place. Then when one would ask for a swap, they new guy would have to overtake the others traction. Whew, am i glad i never got a neck ache in those days.

 

[DisasterMedTech]

If ya'll will read my most recent posting in the stair chair thread...I think it might help understand where Im coming from. THanks.

 

[hippopotassium]

Hey,

While we're on the subject of jaw thrusts, can you use an OPA when you've done a jaw thrust? I can't imagine why not, but one of the TAs in my class (I'm a student) said that you couldn't.

 

[Gbro]

As the OPA keeps the airway open, I say yes. Be careful to keep it in the proper location.