An obstructed airway demands immediate action, as oxygen deprivation can lead to brain damage quickly. When a person is unconscious, the most frequent cause of blockage is the tongue relaxing and falling back against the throat. This soft tissue collapse obstructs the path for air. Before attempting any physical maneuver, immediately call for emergency medical services (such as 911 or your local equivalent).
Standard Method for Airway Positioning
The “Head-Tilt, Chin-Lift” maneuver is the standard technique used to open the airway for an unconscious person without suspected neck or spinal trauma. This maneuver lifts the tongue away from the back of the throat, preventing airflow blockage. To perform this, the rescuer places one hand on the person’s forehead and applies gentle pressure to tilt the head backward.
The fingertips of the other hand are placed under the bony part of the chin (mandible). The chin is then lifted upward to extend the neck and move the jaw forward. Avoid pressing on the soft tissue under the chin, as this could compress the airway.
Once the airway is aligned, check for breathing by looking for chest rise, listening for breath sounds, and feeling for airflow. This repositioning often restores breathing if the obstruction was caused by relaxed anatomy. If the person is not breathing normally, rescue breaths or cardiopulmonary resuscitation (CPR) may be necessary.
Airway Opening for Potential Spinal Injury
If unconsciousness results from trauma, such as a severe fall or car accident, a spinal or neck injury must be assumed. Moving the head and neck to perform the standard Head-Tilt, Chin-Lift maneuver could worsen a cervical spine injury. The “Jaw-Thrust” maneuver is the alternative technique used to minimize head and neck movement.
To perform the Jaw-Thrust, the rescuer kneels at the person’s head and places the heels of both hands on the cheekbones. The fingers are positioned under the angles of the lower jaw. The jaw is gently lifted upward and forward, pulling the tongue away from the throat without tilting the head back.
The Jaw-Thrust uses the mandible to create an open airway. This maneuver is often more challenging and requires ongoing stabilization of the head and neck. Maintaining forward and upward pressure on the jaw is necessary to keep the airway open until medical personnel arrive.
Clearing a Foreign Body Obstruction
An airway obstruction caused by a foreign object (choking) requires different interventions than a positional obstruction. For a conscious adult who cannot cough effectively, the recommended sequence involves administering five back blows followed by five abdominal thrusts. This cycle should be repeated until the object is expelled or the person loses consciousness.
Abdominal thrusts (Heimlich maneuver) are performed by standing behind the person, placing a fist just above the navel, and grasping the fist with the other hand. Quick, inward and upward thrusts are delivered to create a sudden increase in abdominal pressure. This pressure may force air out of the lungs to dislodge the object. For pregnant or morbidly obese individuals, use chest thrusts instead.
If the person becomes unconscious, immediately begin modified CPR, starting with chest compressions. After every 30 chest compressions, open the mouth and look for a visible object. If an object is clearly seen, remove it with a finger sweep. Blind finger sweeps are strictly avoided as they can push the obstruction further into the airway. Continue the cycle of compressions, mouth check, and attempted rescue breaths until the airway clears or emergency help takes over.