Airway management is an immediate priority in any emergency involving an unresponsive person. When consciousness is lost, throat muscles relax, causing the tongue to fall backward and block the upper airway, which is the most common obstruction. Quickly opening the airway is a fundamental skill that prevents brain injury or death, as oxygen deprivation causes irreparable damage in minutes. The technique used depends entirely on whether trauma involving the neck or spine is suspected.
The Standard Technique: Head-Tilt, Chin-Lift
The Head-Tilt, Chin-Lift maneuver is used to open the airway in an unconscious person when no spinal injury is suspected. This technique repositions the head, moving the tongue and soft tissues away from the back of the throat to create a clear path for air. It is effective, easy to use, and requires no specialized equipment.
To perform this on an adult, the rescuer places the heel of one hand on the forehead and applies gentle pressure to tilt the head backward. Simultaneously, the fingers of the other hand are placed under the bony part of the chin and lifted upward.
This movement lifts the jaw forward, pulling the tongue with it. Avoid pressing on the soft tissue under the chin, as this can compress the airway. For infants, the head should only be moved into a neutral or “sniffing” position, since overextending the neck can close their flexible airway.
Airway Management When Spinal Injury is Possible
If an unresponsive person may have suffered trauma, such as a fall or car accident, the Head-Tilt, Chin-Lift is avoided. Tilting the head risks moving the vertebrae, which could cause permanent spinal cord damage. The objective is to open the airway while keeping the head and neck in a neutral, stable alignment.
The alternative is the Jaw-Thrust Maneuver, which lifts the jaw forward without changing the cervical spine position. The rescuer kneels at the person’s head, placing hands on either side for stability. Fingers are positioned under the angles of the lower jaw (mandible).
The jaw is gently lifted upward and forward, pulling the tongue away from the throat. This technique is more challenging to perform and maintain than the Head-Tilt, Chin-Lift. It is the safest method when trauma is suspected, ensuring the airway is open while minimizing neck movement.
Clearing a Foreign Body Obstruction
A different approach is necessary for a foreign body obstruction, such as food, compared to obstructions caused by the tongue. If a conscious person is choking but can still cough forcefully, they should be encouraged to continue, as this is the most effective natural method. If the obstruction is severe and the person cannot cough, talk, or breathe, manual techniques are required.
The basic approach for a conscious adult involves alternating cycles of five back blows and five abdominal thrusts (the Heimlich maneuver). This generates a forceful, artificial cough by rapidly increasing pressure within the chest and lungs. If the person becomes unresponsive, they should be lowered to the ground, and the focus shifts to initiating chest compressions (CPR). After each compression cycle, the mouth should be checked for a visible object that can be safely removed with a finger.