c. Level of Consciousness. When possible, determine the casualty's level of
consciousness using the AVPU system. Ask questions that require more than a "yes"
or "no" answer, such as, "What is your name?" "What is the date?" "Where are we?"
Recheck the casualty's level of consciousness about every 15 minutes to determine if
the casualty's condition has changed.
A--The casualty is alert, knows who he is, the date, where he is, and so
V--The casualty is not alert, but does responds to verbal commands.
P--The casualty responds to pain, but not to verbal commands.
U--The casualty is unresponsive (unconscious).
Maintaining a check on the casualty's level of consciousness is especially
important when the casualty has suffered a head injury.
d. Airway. Assess and secure the casualty's airway (see Lesson 3).
(1) If the casualty is conscious, able to speak, and is not in respiratory
distress, no airway intervention is needed.
If the casualty is unconscious, perform the following.
(a) Use a head-tilt/chin-lift or jaw-thrust to open the airway. The head-
tilt/chin-lift is the normal method of opening the casualty's airway. The jaw-thrust is
used if you suspect that the casualty has suffered a spinal injury.
The muscles of an unconscious casualty's tongue may have relaxed, causing
his tongue to block the airway by sliding to the back of the mouth and
covering the opening to the trachea (windpipe). Using the head tilt/chin-lift or
jaw-thrust to move the tongue away from the trachea may cause the casualty
to resume breathing on his own.
(b) Check the casualty for breathing. Place your ear over the
casualty's mouth and nose with your face toward the casualty's chest while maintaining
the casualty's airway (head-tilt/chin-lift or jaw-thrust). Look for the rise and fall of the
casualty's chest and abdomen. Listen for sounds of breathing. Feel for his breath on
the side of your face. If breathing is not present, begin rescue breathing.
(c) If the casualty is breathing on his own, use a nasopharyngeal
airway (NPA) to maintain the airway.