Maintaining a clear airway is the immediate and most important action in any life-threatening emergency. Obstruction, whether caused by the tongue falling back in an unconscious person or a foreign object, prevents oxygen from reaching the lungs, leading to rapid deterioration. Opening the pathway for breathing requires immediate, decisive action to prevent brain injury or death. This information provides a general understanding of emergency airway maneuvers but is not a replacement for certified, hands-on CPR and First Aid training.
Positioning Techniques for Unresponsive Individuals
When a person loses consciousness, the muscles in the jaw and throat relax, causing the tongue to fall backward and block the upper airway. The standard method to relieve this soft tissue obstruction, assuming no trauma is suspected, is the Head-Tilt/Chin-Lift maneuver. The rescuer places one hand on the person’s forehead and applies gentle pressure to tilt the head backward. Simultaneously, the fingers of the other hand are placed under the bony part of the chin to lift the jaw forward. This motion moves the tongue away from the back of the throat, opening the airway passage.
If there is suspicion of a neck or spinal injury, such as from a fall or car accident, the Head-Tilt/Chin-Lift must be avoided to prevent damage to the cervical spine. The Jaw-Thrust maneuver is the preferred technique because it opens the airway with minimal neck movement. The rescuer kneels at the person’s head, places fingers under the angles of the lower jaw, and pushes the jaw upward and forward. This action lifts the mandible and pulls the tongue away from the pharynx while keeping the head and neck in a neutral position.
Clearing a Blocked Airway (Choking)
Choking occurs when a foreign body blocks the trachea. Severe choking is identified when a person cannot cough forcefully, speak, or breathe, and they may clutch their throat. Immediate intervention is required to generate enough pressure to expel the object. The most common technique for a conscious, choking adult involves a combination of back blows and abdominal thrusts.
The rescuer should first deliver five firm back blows with the heel of the hand between the person’s shoulder blades while the person is leaning forward. If the obstruction is not cleared, the rescuer performs five abdominal thrusts, often known as the Heimlich maneuver. The rescuer stands behind the person, makes a fist just above the navel, covers the fist with the other hand, and delivers quick, inward and upward thrusts. This cycle should be repeated until the object is dislodged or the person becomes unresponsive.
If the person becomes unconscious while choking, they should be lowered to the ground. The emergency protocol then shifts to modified cardiopulmonary resuscitation (CPR). The rescuer begins with chest compressions, and before attempting rescue breaths, they should check the mouth for any visible foreign object. If an object is seen, it should be removed with a finger sweep only if it is clearly visible, avoiding the blind sweep that could push the object further down the throat.
Adapting Airway Maneuvers for Infants and Children
Airway management for pediatric patients requires modifications due to anatomical differences, particularly for infants under one year of age. The large size of an infant’s head relative to their body can cause the neck to flex when lying flat, potentially obstructing the airway. To open an infant’s airway, the head should be placed in a neutral or “sniffing position,” involving only a slight tilt, as hyperextension can close off the trachea. For older children, a slightly more pronounced Head-Tilt/Chin-Lift to achieve the sniffing position is appropriate.
Clearing a foreign body obstruction in an infant differs from the adult method, as abdominal thrusts carry a risk of internal injury. For a conscious, choking infant, the rescuer delivers a sequence of five back blows and five chest thrusts. The infant is held face-down along the rescuer’s forearm with the head lower than the chest, and five back blows are delivered between the shoulder blades. The infant is then turned face-up on the other arm, and five chest thrusts are given with two fingers on the breastbone, just below the nipple line.
Next Steps and Emergency Response
After successfully opening or clearing a person’s airway, the rescuer must ensure that emergency medical services (EMS) have been activated by calling 911 or the local emergency number. If the person remains unconscious, the rescuer must check for normal breathing and a pulse for no more than ten seconds. If the person is not breathing normally, CPR should be initiated according to certified training guidelines.
If the person is unconscious but breathing, they should be placed into the Recovery Position to maintain an open airway and prevent the aspiration of fluids. The person is rolled onto their side, with the upper leg bent at the hip and knee to stabilize the body, and the upper arm supporting the head. This position uses gravity to keep the tongue forward and allows fluids to drain from the mouth, preventing them from entering the lungs. Professional medical evaluation is necessary afterward to check for internal injuries or complications.