This is the first scenario in the Tier 2/Combat Life Saver curriculum pack. The following scenarios will provide training on additional TCCC at the Tier 2 Level. There are new interventions in the Airway, Respirations, Circulation, Head Injury, Hypothermia, and Fracture portions of TCCC. Additionally, Tier 2 introduces you to new medications that can be used for pain as well as infection prevention and treatment. We will proceed sequentially through MARCH.
Tier 2 Airway Treatments (NPA): You are in a SAFE and SECURE location – The primary learning objective is to show you a more advanced way to treat an airway obstruction using a nasopharyngeal (NPA) airway device. The estimated time to complete this scenario is 5 minutes. This scenario occurs in the Tactical Field Care Phase. Equipment Available: Combat Life Saver Pack. Evacuation/Disposition is possible through the tablet. Selecting the patient’s disposition will end the exercise.
Patient Communication
Patient: Can you tell me your name?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you feel any pain?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you have any medical problems?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you have any allergies?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you take any medications?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Are you feeling dizzy or confused?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Are you having trouble breathing?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Can you see clearly?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you feel any swelling in your throat?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Are your lips or tongue swollen?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Is your voice hoarse or different?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Patient: Do you remember what happened?
Response: This patient's breathing is noisy and they are having difficulty talking
Location: Head
Guided Steps
The patient was injured in a blast from a drone attack about 30 minutes ago and other soldiers dragged them to your location. You already washed your hands, put on your gloves, and did a search for massive hemorrhage which was normal. Next, perform an airway assessment. What is this patient's airway exam? Press and hold [B] to proceed to the next step.
The patient is not able to talk and has harsh breathing sounds called stridor that can be heard if you put your head close to the patient's face and mouth. Next, perform an initial airway maneuver to try treating the patient’s airway obstruction. Press and hold [B] to proceed to the next step.
If you tried a jaw thrust or head tilt chin lift or rolling the patient into the recovery position then good job! Next, reassess the patient's airway to see if this helped or fixed the obstruction. Press and hold [B] to proceed to the next step.
The patient still has stridor, which means the airway is still obstructed. Next, we need to place a nasopharyngeal airway. This device is also frequently called an N P A. Open your Combat Life Saver Pack and find the curved tube labeled nasopharyngeal airway N P A and pick it up. Then press and hold [B] to proceed to the next step.
Your kit only has one size of nasopharyngeal airway, but we will measure it for practice. Hold the tube along the patient's face aligning it from the opening of the patient's nose to the opening of the patients ear canal which is near the tragus. A correctly sized tube reaches from the opening of the patients nose to the opening of the patients ear near the tragus.
Informational Step: In real life, to place the tube, you would put some lubricating jelly on the end of the tube, lift the end of the patient’s nose slightly and insert it straight back with the pointy part of the tube rotated away from the patient's midline, which actually points the bevel away from the patients septum. Slowly insert it 1-2 inches or 4-5 centimeters, then you can start to rotate the tube downwards while inserting it the rest of the way until just the flange (flat rim at the end of the tube) is sticking out of the patient's nose.
Informational Step: If you are having a hard time placing the tube, you can try the other nostril, a smaller tube, adding more lubricant, or if you do not have lubricant, you can put some of the patient's own saliva on the tube to help facilitate placement. One of the most frequent mistakes is trying to insert the tube upwards rather than straight back.
Next, put the N P A near the patient's nose and pull the [TRIGGER] to place the N P A. Then, reassess the patient's airway.
The patient's stridor has resolved for now. If you still hear it, then ensure the patient is still also receiving a sustained maneuver such as a jaw thrust, head-tilt-chin-lift, or the recovery position. The combination should resolve it in this patient. Remember, the airway obstruction can always worsen, recur, or the N P A can move or fall out. Sometimes you may need to secure it with a small piece of tape, ensuring that you do not cover the opening at the end.
This concludes your scenario. Next, open your tablet [X], select the disposition tab, and select Medical Evacuation.