The jaw thrust maneuver is an emergency technique used to open the airway of an unresponsive person without moving the head or neck. In an unconscious state, the muscles relax, allowing the tongue and soft tissues to fall backward and block the upper airway. This maneuver is an alternative to the standard head-tilt/chin-lift method, especially when there is a concern for injury. Proper training is necessary before attempting this technique.
Context: Why the Jaw Thrust Maneuver is Essential
The jaw thrust maneuver is used when there is suspected trauma or injury to the head, neck, or spine. This technique opens the airway while minimizing movement of the cervical spine. In trauma situations, unnecessary movement of the neck could potentially worsen an existing spinal cord injury.
The maneuver is effective because it lifts the mandible upward and forward. This action pulls the tongue and other soft tissues away from the posterior wall of the pharynx, clearing the obstruction. By moving the jaw without hyperextending the neck, the rescuer maintains the head and neck in a neutral, in-line position. This distinction is important because the head-tilt/chin-lift maneuver involves backward tilting of the head, which is contraindicated when a spinal injury is possible.
Step-by-Step Execution of the Maneuver
To begin the jaw thrust maneuver, the rescuer should position themselves at the top of the person’s head, kneeling down. The person should be lying flat on their back on a firm surface. Maintaining a neutral head position throughout the process is necessary to avoid rotational or bending movement of the neck.
Place both hands on the sides of the person’s head, resting your palms on their cheeks or temples to stabilize the head. Position your index and middle fingers beneath the angles of the jaw. Your thumbs should rest on the person’s chin for support without applying downward pressure.
Using your index and middle fingers, gently but firmly lift the jaw upward and forward. This motion should cause the lower teeth to move in front of the upper teeth, effectively pulling the tongue base away from the back of the throat. The goal is to create a clear airway passage without tilting or extending the head backward.
If the jaw thrust alone does not fully open the mouth, use your thumbs to slightly push down on the chin to open the mouth a small amount. This action helps ensure a clear path for air flow while maintaining the forward displacement of the jaw. After performing the maneuver, immediately check for signs of breathing by looking for chest rise, listening for breath sounds, and feeling for air movement.
Safety and Precautions During Airway Management
The jaw thrust maneuver can be physically challenging to maintain for an extended period, especially when emergency help may be delayed. It requires skill and strength, making it more difficult to perform than the head-tilt/chin-lift. Difficulties may arise with certain patient anatomies, such as those with severe temporomandibular joint (TMJ) issues or facial or mandibular fractures that prevent jaw movement.
If the initial attempt to perform the jaw thrust maneuver fails to open the airway, securing a clear passage for breathing remains the immediate priority. In such a life-threatening situation, current guidelines suggest that a gentle, minimal head extension may be used as a last resort. The need for oxygen takes precedence over the theoretical risk of worsening a spinal injury, but this should only be done if the jaw thrust is unsuccessful.
The jaw thrust maneuver is a temporary measure, and emergency medical services (911/999) must be called immediately for any unconscious person requiring airway intervention. Continuous monitoring of the person’s breathing and responsiveness is necessary while maintaining the jaw thrust position until professional help arrives. If the person remains unresponsive and is not breathing adequately, the rescuer must be prepared to transition to providing rescue breaths or cardiopulmonary resuscitation (CPR).