The human airway is a delicate passage. When a person becomes unconscious, muscles relax, causing the tongue to fall back and block airflow. This obstruction can stop oxygen from reaching the brain quickly, making immediate intervention necessary. The techniques detailed here are first aid measures designed to quickly open or clear a compromised airway until professional medical help arrives. This information is for educational purposes only and is not a replacement for formal CPR or first aid certification training.
Head-Tilt/Chin-Lift Technique
The Head-Tilt/Chin-Lift technique is the standard method for opening the airway when an unresponsive person is lying flat and a neck or spine injury is not suspected. This maneuver moves the lower jaw forward, pulling the tongue away from the back of the throat. The rescuer should kneel beside the person’s head for optimal access.
To perform the technique, place the heel of one hand on the person’s forehead and apply gentle pressure to tilt the head backward. Simultaneously, place the tips of two fingers from the other hand underneath the bony part of the chin. Lift the chin gently forward and upward, avoiding pressure on the soft tissues of the neck. This combined motion extends the neck and moves the tongue out of the way, allowing for unobstructed breathing.
The chin lift must be maintained while checking for signs of normal breathing, such as the rise and fall of the chest. If the person is not breathing normally, this open position is maintained while delivering rescue breaths or proceeding with cardiopulmonary resuscitation (CPR).
Jaw-Thrust Maneuver
When a neck or spinal injury is suspected, such as after a fall or car accident, the Head-Tilt/Chin-Lift maneuver must be avoided. The Jaw-Thrust Maneuver is the alternative technique used to open the airway while minimizing movement of the head and neck. The rescuer must position themselves directly at the top of the person’s head.
The rescuer places their index and middle fingers on the angles of the person’s lower jaw, just below the ears. Thumbs are placed on the chin for support. By applying firm, upward pressure with the fingers, the rescuer pushes the lower jaw (mandible) forward without moving the head or neck.
This forward displacement pulls the tongue away from the back of the throat, achieving airway patency while maintaining neutral spine alignment. Although the Jaw-Thrust is more difficult to perform and maintain than the Head-Tilt/Chin-Lift, it is the preferred technique when trauma is a concern to protect the spinal cord.
Clearing a Foreign Body Obstruction
Airway compromise can also be caused by a physical object, resulting in choking. Severe choking is recognized when the person is unable to speak, cough forcefully, or breathe, and they may clutch their throat. The accepted protocol for a conscious adult involves the “five and five” approach: a sequence of five back blows followed by five abdominal thrusts.
To deliver back blows, stand slightly to the side and behind the person, supporting their chest with one arm while bending them forward at the waist. Use the heel of the free hand to administer five firm strikes between the person’s shoulder blades. If the object does not dislodge, immediately transition to abdominal thrusts.
For abdominal thrusts, stand behind the person and wrap your arms around their waist. Make a fist with one hand and place it just above the person’s naval. Place the other hand over the fist. Deliver five quick, inward and upward thrusts to create pressure that may expel the foreign object. This cycle is repeated until the obstruction is cleared or the person becomes unresponsive.
Sustaining Airway Patency and Seeking Emergency Help
Once the airway is opened or cleared, the person’s condition requires careful management until emergency medical services (EMS) arrive. If the person remains unresponsive but is breathing normally, they should be placed into the recovery position. This specific side-lying posture helps maintain patency and allows fluids, such as vomit or blood, to drain from the mouth.
The standard recovery position involves rolling the person onto their side. Place the arm nearest the rescuer at a right angle and bend the top knee to stabilize the body. This positioning prevents the tongue from falling back against the throat and reduces the risk of aspiration. The person’s head should be gently tilted back slightly to ensure the airway remains open.
If the person becomes unconscious or if the airway maneuver was performed due to unresponsiveness, EMS must be contacted immediately. Ongoing monitoring of the person’s breathing is necessary while awaiting professional help. Should the person stop breathing normally, the rescuer must immediately place them on their back and begin CPR.