{"id":2570,"date":"2025-11-11T15:04:51","date_gmt":"2025-11-11T13:04:51","guid":{"rendered":"https:\/\/www.military.ch\/reconvilier\/new_site\/?p=2570"},"modified":"2025-11-17T18:21:11","modified_gmt":"2025-11-17T16:21:11","slug":"soins-sous-le-feu-phase-3","status":"publish","type":"post","link":"https:\/\/www.military.ch\/reconvilier\/new_site\/soins-sous-le-feu-phase-3\/","title":{"rendered":"Soins sous le feu phase 3"},"content":{"rendered":"\n<section>\n  <h2>TCCC \u2013 Soins tactiques de terrain (Phase 3)<\/h2>\n  <p>Apr\u00e8s le contr\u00f4le des h\u00e9morragies massives, la deuxi\u00e8me \u00e9tape du protocole MARCH est A \u2013 Airway, soit la gestion des voies a\u00e9riennes. L\u2019objectif est de garantir une respiration libre et efficace chez un bless\u00e9 conscient ou inconscient, tout en tenant compte de la situation tactique et des moyens disponibles.<\/p>\n  \n  <h3>Observation initiale<\/h3>\n  <p><strong>\u00c9valuation des voies a\u00e9riennes :<\/strong><\/p>\n  <ul>\n    <li>V\u00e9rifier la capacit\u00e9 \u00e0 parler ou \u00e0 respirer.<\/li>\n    <li>Observer les mouvements thoraciques, les bruits respiratoires, les signes d\u2019obstruction (gargouillements, sifflements, tirage, cyanose).<\/li>\n    <li>Rechercher les causes possibles d\u2019obstruction : sang, vomissements, corps \u00e9tranger, traumatisme facial, br\u00fblure, etc.<\/li>\n  <\/ul>\n  <p><strong>Remarque TCCC 2024 :<\/strong> La stabilisation cervicale n\u2019est pas n\u00e9cessaire en cas de traumatisme p\u00e9n\u00e9trant isol\u00e9.<\/p>\n\n  <h3>\u00c9valuation de l\u2019\u00e9tat du bless\u00e9<\/h3>\n  <h4>1. Conscient, voies a\u00e9riennes libres<\/h4>\n  <ul>\n    <li>Laisser le bless\u00e9 adopter la position qui facilite sa respiration : assis, pench\u00e9 vers l\u2019avant ou semi-assis.<\/li>\n    <li>Encourager \u00e0 respirer lentement et profond\u00e9ment.<\/li>\n    <li>Surveiller la survenue d\u2019une d\u00e9tresse respiratoire secondaire.<\/li>\n  <\/ul>\n  \n  <h4>2. Inconscient, voies a\u00e9riennes libres<\/h4>\n  <ul>\n    <li>Placer le bless\u00e9 en position lat\u00e9rale de s\u00e9curit\u00e9 (PLS) ou position de r\u00e9cup\u00e9ration :<br>\n        &#8211; T\u00eate l\u00e9g\u00e8rement inclin\u00e9e vers l\u2019arri\u00e8re.<br>\n        &#8211; Menton relev\u00e9.<br>\n        &#8211; Bouche ouverte pour favoriser le drainage.<\/li>\n    <li>Utiliser la bascule du menton (Chin lift) ou la subluxation mandibulaire (Jaw thrust) si aucun traumatisme facial majeur ne l\u2019emp\u00eache.<\/li>\n  <\/ul>\n  \n  <p><a href=\"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-content\/uploads\/jaw_thrust_chin_lift.jpg\" target=\"_blank\"><img decoding=\"async\" src=\"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-content\/uploads\/jaw_thrust_chin_lift.jpg\" alt=\"Jaw Thrust et Chin Lift\" style=\"max-width:100%; height:auto;\"><\/a><\/p>\n\n  <div class=\"video-wrapper\" style=\"margin-bottom:15px;\">\n    <iframe src=\"https:\/\/player.vimeo.com\/video\/1135681349?h=0&#038;title=0&#038;byline=0&#038;portrait=0\" width=\"640\" height=\"360\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen title=\"Voie a\u00e9rienne et Jaw Thrust\"><\/iframe>\n  <\/div>\n\n  <h4>3. Obstruction ou risque d\u2019obstruction<\/h4>\n  <ul>\n    <li>Nettoyer la cavit\u00e9 buccale : retirer sang, vomissements, corps \u00e9trangers si pr\u00e9sents.<\/li>\n    <li>Aspirer les s\u00e9cr\u00e9tions si le mat\u00e9riel est disponible.<\/li>\n    <li>Si l\u2019obstruction persiste malgr\u00e9 ces gestes simples :<br>\u2192 passer \u00e0 une intervention directe sur les voies a\u00e9riennes.<\/li>\n  <\/ul>\n\n  <h3>Gestion des voies a\u00e9riennes selon le TCCC 2024<\/h3>\n\n  <h4>Option 1 \u2013 Mesures de base<\/h4>\n  <ul>\n    <li>Airway maneuvers : Chin lift, Jaw thrust.<\/li>\n    <li>Canule nasopharyng\u00e9e (NPA) :<br>\n        &#8211; Taille adapt\u00e9e (du lobe de l\u2019oreille \u00e0 la narine).<br>\n        &#8211; Lubrifi\u00e9e et ins\u00e9r\u00e9e doucement dans la narine libre.<br>\n        &#8211; Ne jamais forcer si r\u00e9sistance.<br>\n        &#8211; Essayez l\u2019autre narine en cas de difficult\u00e9.<br>\n        &#8211; Contr\u00f4ler que l\u2019air passe correctement.<br>\n        &#8211; Mettre le bless\u00e9 en position lat\u00e9rale de s\u00e9curit\u00e9.<\/li>\n  <\/ul>\n\n  <p><strong>Indication :<\/strong> bless\u00e9 inconscient mais respirant spontan\u00e9ment, sans traumatisme facial majeur. L\u2019avantage avec la canule nasopharyng\u00e9e, c\u2019est qu\u2019elle est mieux support\u00e9e qu\u2019une canule oropharyng\u00e9e (canule de Guedel), surtout quand il reprend conscience, ce qui provoque beaucoup moins de vomissements.<\/p>\n\n  <div class=\"video-wrapper\" style=\"margin-bottom:15px;\">\n    <iframe src=\"https:\/\/player.vimeo.com\/video\/1133208156?h=0&#038;title=0&#038;byline=0&#038;portrait=0\" width=\"640\" height=\"360\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen title=\"Pose canule nasopharyng\u00e9e\"><\/iframe>\n  <\/div>\n\n  <h4>Option 2 \u2013 Mesures avanc\u00e9es<\/h4>\n  <p>Il a \u00e9t\u00e9 observ\u00e9 que dans de nombreux cas pr\u00e9sentant des traumatismes maxillofaciaux, la position assise et la t\u00eate pench\u00e9e en avant permettent au sang de s\u2019\u00e9couler et de continuer \u00e0 respirer normalement.<\/p>\n  <p>Si les mesures pr\u00e9c\u00e9dentes sont insuffisantes et qu\u2019une <strong>obstruction traumatique<\/strong> est av\u00e9r\u00e9e (\u00e9crasement facial, br\u00fblure, plaie p\u00e9n\u00e9trante du cou, etc.) :<\/p>\n\n  <ul>\n    <li><strong>a) Cricothyro\u00efdotomie chirurgicale :<\/strong><br>\n        Proc\u00e9dure d\u2019urgence pour r\u00e9tablir une ventilation en cas d\u2019obstruction compl\u00e8te ou mena\u00e7ante.<\/li>\n    <ul>\n      <li>Technique \u201cCricKey\u201d (pr\u00e9f\u00e9r\u00e9e) \u2013 avec guide rigide et canule \u00e0 ballonnet.<\/li>\n      <li>Technique chirurgicale assist\u00e9e par bougie \u2013 incision horizontale sur la membrane cricothyro\u00efdienne, insertion guid\u00e9e.<\/li>\n      <li>Technique chirurgicale standard \u2013 incision simple sans bougie, avec canule 6-7 mm interne, 5-8 cm intratrach\u00e9ale.<\/li>\n    <\/ul>\n  <\/ul>\n\n  <p><strong>\u00c9tapes cl\u00e9s :<\/strong><\/p>\n  <ul>\n    <li>Identifier la membrane cricothyro\u00efdienne.<\/li>\n    <li>Inciser horizontalement, introduire la canule et gonfler le ballonnet.<\/li>\n    <li>V\u00e9rifier la bonne position par <strong>capnographie (EtCO\u2082)<\/strong>.<\/li>\n    <li>Administrer <strong>lidoca\u00efne<\/strong> si le patient est conscient.<\/li>\n    <li>Fixer la canule et poursuivre la surveillance.<\/li>\n  <\/ul>\n\n  <div class=\"video-wrapper\" style=\"margin-bottom:10px;\">\n    <iframe src=\"https:\/\/player.vimeo.com\/video\/1135674295?h=0&#038;title=0&#038;byline=0&#038;portrait=0\" width=\"640\" height=\"360\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen title=\"Cricothyro\u00efdotomie CricKey\"><\/iframe>\n  <\/div>\n\n  <div class=\"video-wrapper\" style=\"margin-bottom:15px;\">\n    <iframe src=\"https:\/\/player.vimeo.com\/video\/1133207983?h=0&#038;title=0&#038;byline=0&#038;portrait=0\" width=\"640\" height=\"360\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen title=\"Cricothyro\u00efdotomie avec canule\"><\/iframe>\n  <\/div>\n\n  <p><em>Les vid\u00e9os utilis\u00e9es dans cet article proviennent du Committee on Tactical Combat Casualty Care (CoTCCC), \u00e0 titre d&rsquo;illustrations p\u00e9dagogiques officielles pour la gestion des voies a\u00e9riennes.<\/em><\/p>\n\n  <h3>Surveillance continue<\/h3>\n  <ul>\n    <li>V\u00e9rifier r\u00e9guli\u00e8rement la perm\u00e9abilit\u00e9 des voies a\u00e9riennes.<\/li>\n    <li>Surveiller la saturation en oxyg\u00e8ne (SpO\u2082) et la capnographie (EtCO\u2082) si disponible.<\/li>\n    <li>R\u00e9\u00e9valuer \u00e0 chaque mouvement ou changement de position.<\/li>\n    <li>R\u00e9\u00e9valuer apr\u00e8s tout \u00e9pisode de perte de conscience ou de vomissement.<\/li>\n    <li>O2 si disponible.<\/li>\n  <\/ul>\n\n  <h3>Surveillance continue \u2013 SpO\u2082 &#038; EtCO\u2082<\/h3>\n  <p>En compl\u00e9ment de la prise en charge des voies a\u00e9riennes, la surveillance continue de la saturation en oxyg\u00e8ne et de la capnographie est fortement recommand\u00e9e.<\/p>\n\n  <div style=\"display: flex; justify-content: space-between; gap: 20px;\">\n    <div style=\"text-align: center; flex: 1;\">\n      <img decoding=\"async\" src=\"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-content\/uploads\/Oxymetre_YK-80B.png\" alt=\"Oxym\u00e8tre portable YK-80B\" style=\"max-width: 150px; height: auto;\">\n      <p><strong>Oxym\u00e8tre portable YK-80B<\/strong><br>(moins de 30 CHF)<\/p>\n    <\/div>\n    <div style=\"text-align: center; flex: 1;\">\n      <img decoding=\"async\" src=\"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-content\/uploads\/Capnographe_EMMA.png\" alt=\"Capnographe EMMA\" style=\"max-width: 150px; height: auto;\">\n      <p><strong>Capnographe EMMA<\/strong><br>(environ 2&rsquo;000 CHF)<\/p>\n    <\/div>\n  <\/div>\n\n  <p><em>Prix indicatifs \u00e0 titre d\u2019information \u2013 v\u00e9rifier les modalit\u00e9s d\u2019achat et compatibilit\u00e9 militaire.<\/em><\/p>\n\n  <h3>Niveaux de comp\u00e9tence TCCC<\/h3>\n  <ul class=\"tccc-levels\">\n    <li><span style=\"color:#2e8b57;\">\u25cf<\/span> <strong>Tous les combattants<\/strong><\/li>\n    <li><span style=\"color:#ff8c00;\">\u25cf<\/span> <strong>Secouristes m\u00e9dicaux de combat (sanitaires)<\/strong><\/li>\n    <li><span style=\"color:#b22222;\">\u25cf<\/span> <strong>Paramedics de combat \/ M\u00e9dics forces sp\u00e9ciales<\/strong><\/li>\n  <\/ul>\n\n  <h3>Ressource t\u00e9l\u00e9chargeable<\/h3>\n  <p><a class=\"btn-asso\" href=\"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-content\/uploads\/MARCH_3.pdf\" target=\"_blank\" rel=\"noopener\">T\u00e9l\u00e9charger la fiche \u201cTCCC \u2013 Airway (Phase 3)\u201d (PDF)<\/a><\/p>\n\n  <div class=\"encadre-avertissement\" style=\"background:#f4f6f1; border-left:4px solid #556b2f; padding:10px 15px; margin:20px 0; font-size:0.95em;\">\n  <strong>Avertissement :<\/strong><br>\n  Cette fiche est une adaptation p\u00e9dagogique du protocole <strong>TCCC 2024<\/strong>, r\u00e9alis\u00e9e par l\u2019<strong>ASSO Reconvilier<\/strong> pour la formation et la sensibilisation \u00e0 la m\u00e9decine tactique.<br>\n  Elle rend hommage au <strong>Committee on Tactical Combat Casualty Care (CoTCCC)<\/strong>.<br>\n  <em>Ce document ne remplace pas une formation reconnue telle que le <strong>TECC<\/strong> ou le <strong>TCCC<\/strong>, ni les d\u00e9l\u00e9gations de comp\u00e9tence propres \u00e0 votre unit\u00e9.<\/em>\n<\/div>\n\n  <p class=\"small\">\n    R\u00e9f\u00e9rence : <a href=\"https:\/\/deployedmedicine.com\/\" target=\"_blank\" rel=\"noopener\">Deployed Medicine \u2013 Tactical Combat Casualty Care<\/a>\n  <\/p>\n<\/section>\n","protected":false},"excerpt":{"rendered":"<p>TCCC \u2013 Soins tactiques de terrain (Phase 3) Apr\u00e8s le contr\u00f4le des h\u00e9morragies massives, la deuxi\u00e8me \u00e9tape du protocole MARCH est A \u2013 Airway, soit la gestion des voies a\u00e9riennes. <a class=\"more-link\" href=\"https:\/\/www.military.ch\/reconvilier\/new_site\/soins-sous-le-feu-phase-3\/\">Lire la suite&#8230;<\/a><\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[77],"tags":[],"class_list":["post-2570","post","type-post","status-publish","format-standard","hentry","category-medic"],"_links":{"self":[{"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/posts\/2570","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/comments?post=2570"}],"version-history":[{"count":15,"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/posts\/2570\/revisions"}],"predecessor-version":[{"id":2597,"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/posts\/2570\/revisions\/2597"}],"wp:attachment":[{"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/media?parent=2570"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/categories?post=2570"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.military.ch\/reconvilier\/new_site\/wp-json\/wp\/v2\/tags?post=2570"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}