Securing a clear airway is a fundamental step in emergency resuscitation for an unresponsive person who is not breathing normally. When consciousness is lost, the muscles in the jaw and throat relax, causing the tongue to fall back and create a blockage. Clearing this passage allows oxygen to reach the lungs so rescue breaths can be delivered effectively. Correct application of airway opening techniques provides the necessary pathway for ventilation to begin.
Executing the Head-Tilt/Chin-Lift Maneuver
The standard approach for opening the airway in an unresponsive individual is the head-tilt/chin-lift maneuver, which is used when there is no suspicion of a neck or spinal injury. This technique works by mechanically lifting the tongue away from the back of the throat through the repositioning of the head and jaw. The single rescuer should first kneel beside the person’s head to easily access both the forehead and chin.
To execute the tilt, the rescuer places one hand, specifically the palm, on the person’s forehead and applies gentle, steady pressure to tilt the head backward. This rearward movement of the head straightens the airway and is coordinated with the second part of the technique. With the other hand, the rescuer places the tips of their index and middle fingers beneath the bony part of the chin.
The chin is then gently lifted upward, which displaces the mandible forward and helps to pull the tongue away from the pharyngeal wall, completing the airway opening. Lift the chin without pressing on the soft tissues under the chin, as this pressure could inadvertently push the tongue back and worsen the obstruction. The goal is to achieve slight mouth opening without closing it completely, which would interfere with the delivery of a rescue breath.
When to Use the Jaw Thrust Technique
The jaw thrust maneuver is reserved for situations where a single rescuer suspects the unresponsive person may have a cervical spine injury (e.g., from a fall or car accident). The standard head-tilt/chin-lift is avoided because tilting the head could cause further damage to the spinal cord. The jaw thrust opens the airway by moving the jaw forward while maintaining the head and neck in a neutral, in-line position to minimize spinal movement.
To perform this, the single rescuer kneels at the person’s head and places the heels of both hands on the sides of the head. The fingers are then positioned under the angles of the lower jaw, which is the bony part near the ears. The rescuer uses their fingers to firmly and gently push the jaw forward and upward, displacing the mandible without extending the neck.
This forward displacement of the lower jaw achieves the same goal as the head-tilt/chin-lift—moving the tongue away from the back of the throat—but it does so while stabilizing the head. The jaw thrust is more difficult for a single rescuer to maintain while delivering rescue breaths, as it requires both hands to hold the jaw in position. It should therefore be used only when the potential risk of neck injury overrides the efficiency of the standard technique.
Checking for Breathing and Delivering Rescue Breaths
Once the airway has been successfully opened, the single rescuer must immediately check for signs of breathing, which should take no more than ten seconds. This assessment involves looking for the rise and fall of the chest, listening for breath sounds, and feeling for the movement of air. If the person is not breathing or is only gasping occasionally, rescue breaths must be delivered immediately.
To deliver a rescue breath, the rescuer maintains the open airway position, using the hand on the forehead to pinch the person’s nose closed. A tight seal is then created by placing the rescuer’s mouth completely over the person’s mouth. The rescuer delivers a breath lasting approximately one second, watching the person’s chest to confirm that it visibly rises.
If the chest rises, the rescuer removes their mouth to allow the chest to fall as the air passively exits. A second breath, lasting one second, is then delivered, again confirming chest rise. If the chest does not rise after the first attempt, the rescuer should quickly re-adjust the head-tilt/chin-lift position before attempting the second breath. The two rescue breaths are delivered in sequence before moving on to the next step of cardiopulmonary resuscitation, such as chest compressions.