Maintaining an open airway is crucial in emergencies, especially with suspected neck or spinal injuries. An obstructed airway can quickly lead to brain damage or death. Improper handling can worsen spinal cord damage, causing paralysis or severe complications. Therefore, techniques that minimize neck movement are essential.
Standard Airway Opening Methods
Common methods for opening an airway in an unconscious person typically involve manipulating the head and neck. The head-tilt/chin-lift maneuver, for instance, involves tilting the head backward and lifting the chin to move the tongue away from the back of the throat, clearing the airway. This technique is effective when a neck injury is not suspected.
However, these standard approaches are contraindicated when a spinal injury is a possibility. Tilting the head back or moving the neck can cause hyperextension of the cervical spine, potentially compressing or severing the spinal cord. Such movements can worsen an injury, leading to further neurological deficits or paralysis. Therefore, a specialized method is needed to manage the airway safely in these cases.
The Jaw-Thrust Maneuver
When a neck injury is suspected, the jaw-thrust maneuver is the preferred technique for opening the airway because it minimizes movement of the cervical spine. To perform this maneuver, position yourself at the person’s head, ensuring they are lying on their back on a firm, flat surface. Place your elbows on the surface the person is on, providing stability.
Place your index and middle fingers on the angles of the person’s lower jaw (mandible), near the ears. Your thumbs should rest on the person’s cheekbones or chin, providing counter-pressure and support. Gently and steadily, lift the jaw forward and upward with your fingers, aiming to bring the lower teeth higher than the upper teeth. This action displaces the tongue from the back of the throat, opening the airway without extending the neck. Avoid applying pressure to the soft tissues of the neck, as this could obstruct the airway further.
Identifying a Suspected Neck Injury
Recognizing the signs and circumstances that suggest a neck or spinal injury is paramount, as it dictates the appropriate airway management technique. A suspected neck injury often arises from high-impact events such as motor vehicle accidents, falls from significant heights (greater than 1 meter), or diving incidents. Blunt trauma to the head or neck area, or any situation where an unconscious person’s injury cause is unknown, also warrants suspicion.
Specific symptoms can indicate a potential cervical spine injury. These include pain or tenderness in the neck or back, especially along the midline of the spine. Neurological signs like numbness, tingling, or weakness in the arms or legs, or difficulty moving limbs, are serious indicators of nerve or spinal cord involvement. Altered consciousness, a dazed appearance, or visible signs of injury such as bruising, swelling, or an unnatural position of the head or body, also necessitate assuming a spinal injury until proven otherwise.
Immediate Steps After Opening the Airway
Once the airway is successfully opened using the jaw-thrust maneuver, maintaining it is the immediate priority. Keep your hands in position to hold the jaw forward, ensuring the airway remains clear. Simultaneously, quickly check for breathing by looking for chest rise and fall, listening for breath sounds, and feeling for air movement from the mouth or nose.
While maintaining the airway, it is imperative to call for emergency medical services (EMS) immediately. If the person is not breathing, and you are trained to do so, begin rescue breathing, ensuring you continue to use the jaw-thrust maneuver to keep the airway open. Avoid moving the person unless absolutely necessary for safety, such as if they are in immediate danger or if they begin to vomit. The goal is to keep the person as still as possible, minimizing any further movement of the head and neck, until professional medical help arrives and can take over care.