 For initial task training for MOS-91B10, basic medical specialist, this videotape is to be used only with a qualified instructor present. However, this videotape may be used independently without an instructor present by soldiers who are MOS qualified, but require refresher training in performing the task presented. In the field, you may find a soldier who appears to have an airway obstruction. He may be unconscious and his breathing may be labored. He may not be breathing at all. In addition, his face may have a bluish tint to it. You, the medical aidman, will want to take immediate action to solve this breathing problem before you tend to any other injuries. In such cases, you will want to open the airway. You can open the patient's airway by any one of four methods known as the head tilt, the thumb jaw lift, also called the chin lift, the two-handed jaw lift, and the modified jaw thrust. When you first encounter the patient, who you suspect has an airway obstruction, check him for injuries and gently shake and call to him. If the patient does not respond, position him face up. To do this, grasp his hip clothing and his shoulder on the side farthest away from you and carefully pull him toward you. Now, open his airway. To open the airway using the head tilt method, first place one hand under the patient's neck and the other hand on his forehead. Then, lift up the neck while you push down the forehead. His chin should point in the air. Remember, if you suspect that this patient has a neck or spinal fracture, do not use the head tilt method. You can also open the airway with the thumb jaw lift. To perform this, place one hand on the patient's forehead. Then, place one bent forefinger of the other hand under the patient's chin and the thumb of the same hand inside the patient's mouth and over his bottom teeth. Then, gently lift the chin while you steady the forehead. Another method is the two-handed jaw lift. Perform this task by placing your hands on either side of the patient's head with your fingers at the jaw and below the earlobes and your thumbs below the lower lips. Now, lift up the jaw with your fingers and push down the chin with your thumbs. Use this lift when the patient's teeth are tightly clenched. The modified jaw thrust is helpful in opening the airway of a patient who you suspect has a spine or neck fracture. First, place your hands on either side of your patient's head with the small and ring fingers on the jaw under his earlobe and the middle and index fingers along the jaw line. Your thumbs should be on the patient's upper lips. When your fingers are positioned, move the jaw forward without tilting his head backward or to his sides. If his airway still does not open, tilt his head back slightly. After you open the airway, check for new signs of breathing. Put your ear directly over the patient's mouth and nose and observe his chest for movement. Also, listen for sounds in the throat and lungs. Now, you practice. Many times you will encounter a casualty who not only needs his breathing restored, but he needs it maintained by mechanical means. Such a patient will need a piece of tubing in his mouth that will keep his tongue and any other loose material from stopping his airflow. This device is called an oral pharyngeal airway. Before you insert the airway, you will want to follow normal resuscitation procedures. First, survey the casualty and check for response. Shake the patient and shout to him. Second, open the airway. Hyper extend his neck. Third, check for breathing. To do this, put your ear over his mouth and nose and watch his chest. If there is no breathing, ventilate his lungs. That is, perform mouth-to-mouth resuscitation. Blow four quick breaths into his mouth while pinching his nostrils. Fourth, check his pulse at the carotid area on his neck. If he is still not breathing, continue ventilating once every three to five seconds. If normal breathing cannot be maintained, an oral pharyngeal airway can be used to keep the airway open. A patient's airway is open when you hyper extend the neck, but you must keep this opening clear if the patient is going to breathe. The oral pharyngeal airway provides a wedge that holds an unconscious patient's airway open. First, measure the airway by placing it next to the patient's jaw. Measure from the corner of the mouth to the tip of the ear. Choose the correct size from among the different sizes you have available in your medical aid bag. To insert the tube, open the patient's mouth with your fingers, being careful to keep the neck hyper extended. Now, hold the patient's tongue and insert the airway directly into his mouth. One caution. Do not use the oral pharyngeal airway with a conscious patient or with one who is having a convulsion. Now, practice this task yourself.