12 Airway Management

Airway management is required to provide an open airway when the patient:

  • Is unconscious;
  • Has an obstructed airway;
  • Needs rescue breathing.

For unresponsive adults and children, it is reasonable to open the airway using the head tilt – jaw lift manoeuvre. For first aid people performing compression only CPR, there is insufficient evidence to recommend the use of any specific passive airway manoeuvre. However, the value of maintaining an open airway with breaths is highly beneficial to the patient.

Head Tilt / Jaw lift

One hand is placed on the forehead or the top of the head. The other hand is used to provide Jaw Lift. The head (NOT the neck) is tilted backwards. It is important to avoid excessive force, especially where neck injury is suspected. When the patient is in a side position, the head will usually remain in this position when the first aider's hands are withdrawn.

Jaw Lift is commonly used in conjunction with backward head tilt. The chin is held up by the first aider's thumb and fingers in order to open the mouth and pull the tongue and soft tissue away from the back of the throat.

One technique involves placing the thumb over the chin below the lip and supporting the tip of the jaw with the middle and index finger lying along the jaw line. Care is required to prevent the ring finger from squashing the soft tissues of the neck. The jaw is held open slightly and gently pulled from the chest.

Children and Infants

An infant is defined as younger than one year, a child as one to eight years of age.

Maintain an open airway

  • Children should be managed as for adults.
  • The upper airway in infants is easily obstructed because of the narrow nasal passages, the entrance of the windpipe. The trachea is soft and pliable and may be distorted by excessive backward head tilt or jaw thrust. Therefore, in infants the head should be kept neutral and maximum head tilt should not be used. The lower jaw should be supported at the point of chin with the mouth maintained open. There must be no pressure on the soft tissues of the neck. If these manoeuvres do not provide a clear airway, the head may be tilted backwards very slightly with gentle movement.

Recognition of upper airway obstruction

Airway obstruction may be partial or complete and may be present in the conscious or the unconscious patient. Some typical causes of airway obstruction may include, but are not limit to:

  • Relaxation of the airway due to unconsciousness;
  • Inhaled foreign body;
  • Trauma to the airway;
  • Anaphylactic reaction.

The symptoms and signs of obstruction will depend on the cause and severity of the condition. Airway obstruction may be gradual or sudden in onset and may lead to complete obstruction within a few seconds, consequently the patient should be observed continually.

In the conscious patient who has inhaled a foreign body, there may be extreme anxiety, agitation, gasping sounds, coughing or loss of voice. This may progress to the universal chocking sign (clutching the neck with the thumb and fingers).

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