The Head Tilt Chin Lift (HTCL) maneuver is a non-invasive, fundamental technique used in emergency first aid and basic life support. Its sole purpose is to establish and maintain an open, or patent, airway in an unresponsive person. This simple manual procedure effectively repositions the head and neck to alleviate a common cause of upper airway obstruction. Performing the Head Tilt Chin Lift is the standard method for clearing the airway when a person is unconscious and no trauma is suspected.
Initial Assessment and Patient Positioning
Before attempting the Head Tilt Chin Lift, it is necessary to confirm the patient is unresponsive and requires airway assistance. An unconscious individual’s muscles relax completely, including the muscles supporting the lower jaw and tongue. This loss of muscle tone causes the tongue to fall back against the posterior pharyngeal wall, blocking the passage of air.
The patient must be supine, lying face-up, on a flat and firm surface to ensure stability during the maneuver. This positioning allows for maximum mechanical effect when the technique is applied. The goal is physically moving the tongue away from the back of the throat.
Step-by-Step Head Tilt Chin Lift Technique
To begin the maneuver, kneel beside the patient’s head. Place the palm of one hand directly onto the person’s forehead. Use the weight of your hand to apply gentle but firm downward pressure, which initiates the backward tilt of the head.
With the index and middle fingers of your other hand, locate the bony part of the chin near the jawline. Place these two fingers only on the bone and avoid pressing into the soft tissue beneath the chin. Pressing the soft tissue could inadvertently push the base of the tongue back further, worsening the obstruction.
Continue the downward pressure on the forehead while simultaneously lifting the chin upward and forward. This combined action extends the neck and lifts the mandible, mechanically pulling the tongue forward and away from the airway opening. The final position should result in the mouth being slightly open, establishing a clear path for air to flow. Maintain this position consistently to ensure the airway remains clear.
Safety Precautions and Spinal Injury Considerations
The Head Tilt Chin Lift technique involves significant movement of the cervical spine, which presents a safety risk in specific situations. If there is any suspicion of a head, neck, or spinal injury, such as from a fall or car accident, this maneuver should not be performed. Moving the head in the presence of an unstable spinal injury could potentially cause or worsen spinal cord damage.
In cases where a cervical spine injury is suspected, the recommended alternative is the Jaw Thrust maneuver. The Jaw Thrust technique is designed to open the airway by lifting the jaw forward without requiring the head or neck to be tilted backward. Utilizing the Jaw Thrust in these trauma situations is the appropriate method to relieve airway obstruction while minimizing movement of the neck vertebrae. A careful initial assessment is necessary to determine the safest method of airway management.
Confirming Airway Patency and Next Steps
Once the Head Tilt Chin Lift has been successfully performed, the rescuer must immediately check for normal breathing. This check involves the “Look, Listen, and Feel” method, which should take no more than 10 seconds. Look for the chest rising and falling, listen for the sound of air movement, and feel for the patient’s breath on your cheek.
If the patient is breathing normally after the airway is opened, they should be placed into the recovery position to protect the airway until medical help arrives. If the patient is not breathing or is only gasping, immediate action is necessary to provide oxygen. The rescuer must then maintain the open airway and initiate rescue breathing or cardiopulmonary resuscitation (CPR).