Airway patency refers to an open and clear passage for air to travel from the nose and mouth all the way down to the lungs. This unobstructed pathway is the first and most immediate priority in any emergency or first-aid situation. Without a patent airway, oxygen cannot reach the brain and other vital organs, leading to irreversible damage within minutes. Understanding how to quickly assess and manage a compromised airway using basic, non-invasive techniques is a life-saving skill.
Recognizing Signs of Airway Compromise
Airway obstruction is identified through visual and auditory cues signaling a partial or complete blockage. Audible signs indicate a partial obstruction and are categorized by the sound they produce.
A gurgling sound suggests the presence of liquid or secretions, such as vomit or blood, within the airway. Snoring noises, particularly in an unconscious person, usually mean the tongue has relaxed and fallen back against the throat, a common form of soft tissue obstruction. Stridor, a high-pitched, harsh sound heard upon inhalation, is a serious indicator of significant narrowing in the upper airway, often near the voice box. Wheezing, a musical sound on exhalation, points toward a lower airway issue, like asthma or a foreign body deeper in the chest.
A complete obstruction is characterized by a disturbing silence; the person is unable to speak, cough, or make any sound, despite obvious efforts to breathe.
Visible signs of a person struggling to get air include the use of accessory muscles in the neck and shoulders to force inhalation. Paradoxical chest movement, also called “seesaw” breathing, occurs when the chest moves inward while the abdomen pushes outward during inhalation, the reverse of normal breathing patterns. This abnormal motion signals a severe blockage or respiratory muscle fatigue. Cyanosis, a bluish discoloration of the lips, nail beds, or skin, is a late and ominous sign indicating dangerously low oxygen levels in the blood.
Primary Assessment Methods
The initial assessment of a patient who is not speaking or appears unresponsive begins by determining their level of consciousness. If the person is conscious, the most immediate way to assess patency is to ask a simple question, such as “Are you okay?” A person who can speak clearly, even in short phrases, has a functional, patent airway. If they can only speak in short, breathless sentences, it suggests they are having difficulty moving air.
For an unresponsive patient, a standardized assessment must be performed to check for breathing. This sequential approach is known as the “Look, Listen, Feel” technique, though modern protocols emphasize a rapid “Look.” To perform this, kneel beside the patient’s head and position your ear and cheek close to their mouth and nose while looking toward their chest.
The “Look” component involves observing the chest and abdomen for rhythmic rise and fall, which indicates air movement. “Listen” means actively listening for the sound of air passing in and out. “Feel” requires sensing the warmth and movement of the patient’s breath against your cheek. This entire assessment should take no more than ten seconds to determine if normal breathing is present.
Immediate Airway Opening Maneuvers
If the initial assessment confirms an obstructed airway or a lack of normal breathing, immediate physical maneuvers are required to move the soft tissues blocking the passage. In an unresponsive person, the most common cause of obstruction is the tongue falling back and occluding the pharynx due to muscle relaxation. The Head-tilt/chin-lift is the standard, preferred technique to correct this obstruction.
To perform the Head-tilt/chin-lift, place one hand on the person’s forehead and apply gentle, firm pressure backward to tilt the head. Simultaneously, place the fingertips of the other hand under the bony part of the chin and lift it forward. This dual action lifts the tongue away from the back of the throat, effectively opening the airway. This maneuver should be used unless there is a specific concern for a neck or spinal injury.
When a head, neck, or severe facial injury is suspected, the Jaw thrust maneuver is the designated alternative, as it opens the airway with minimal movement of the neck. To perform the Jaw thrust, place one hand on each side of the patient’s head, resting your fingers on the angles of the jawbone. Then, lift the jaw with both hands, pushing it forward. These maneuvers are temporary solutions that must be maintained until the patient recovers consciousness or advanced help arrives.
Maintaining Patency and Positioning
Once the airway has been successfully opened and the patient is breathing spontaneously, the next step is to ensure that patency is maintained, especially if the person remains unresponsive. Leaving an unconscious patient lying flat on their back poses the risk of the tongue relaxing again and blocking the airway, or the patient aspirating secretions or stomach contents. For a patient who is unconscious but breathing, the Recovery Position is used to provide ongoing protection.
The Recovery Position places the patient on their side, using gravity to keep the tongue forward and allow any fluids to drain safely from the mouth. To move the patient, first place the arm nearest to you out at a right angle. Then, bring the arm farthest from you across the patient’s chest and hold the back of their hand against the cheek nearest to you. Bend the far leg at the knee and use it as a lever to gently roll the patient toward you onto their side.
Once positioned, the bent knee prevents the patient from rolling onto their stomach, and the top arm supports the head, maintaining a slight head-tilt to keep the airway open. The position should be stable, and the head should be angled downward to facilitate drainage. Continuous monitoring of the patient’s breathing and responsiveness is necessary until emergency medical services arrive.