The Jaw Thrust Maneuver (JTM) is a technique used to manually open an obstructed airway in an unconscious person. Its function is to reposition the lower jaw (mandible) forward, pulling the tongue and soft tissues away from the back of the throat, clearing the passage for air. The JTM is distinguished from the common head-tilt/chin-lift maneuver because it achieves airway patency without requiring the head or neck to be moved backward. It is a fundamental skill in emergency medicine and basic life support.
Understanding When to Use Jaw Thrust
The unique application of the JTM relates to the potential for a cervical spine (C-spine) injury, common in trauma situations like car accidents or significant falls. In an unconscious patient, the airway often becomes blocked when muscles relax and the tongue falls against the back of the throat. While the head-tilt/chin-lift is effective, the neck extension it requires could aggravate an unstable spinal fracture.
The JTM is the preferred method when a spinal injury is suspected because it allows the rescuer to open the airway while maintaining the neck in a neutral, in-line position. Moving a fractured vertebra could sever the spinal cord, causing paralysis or death. The method chosen must protect the neck from rotational or hyperextension forces. The guiding principle is to maintain manual in-line stabilization (MILS) of the neck while displacing the mandible forward.
Step-by-Step Guide for the Single Rescuer
The single rescuer should kneel at the top of the patient’s head, ensuring the patient is lying supine on a firm surface with the head and body in a straight line. The rescuer places the index and middle fingers of both hands under the angles of the lower jaw, near the ears. The heels of the hands should rest gently on the patient’s cheeks or cheekbones to stabilize the head.
The next action involves using the fingers to firmly lift the jaw upward and forward, displacing the mandible. This forward motion pulls the tongue away from the throat, opening the airway. The rescuer’s thumbs can be placed on the chin to stabilize the jaw and gently open the mouth slightly, if needed, to facilitate breathing. The head and neck must remain motionless, with force applied only to the jawbone, and this position must be maintained continuously.
Adjustments for Pediatric Patients and Assisted Care
The JTM requires modification for pediatric patients due to their distinct anatomical differences. Children have proportionally larger heads, a more flexible trachea, and a smaller airway, meaning excessive force can easily cause trauma or collapse the airway. When performing the maneuver on an infant or child, the rescuer must apply significantly gentler pressure to the angles of the mandible.
The two-person technique, often called assisted care, is utilized in trauma situations to enhance spinal protection. In this variation, one rescuer maintains MILS by holding the patient’s head steady and preventing movement. The second rescuer performs the JTM, focusing entirely on displacing the jaw forward to open the airway. This division of labor ensures the highest degree of cervical spine protection while maximizing airway opening effectiveness.
Troubleshooting and Ensuring Airway Patency
A common failure point in the JTM is inadequate displacement of the jaw, often caused by not lifting the mandible far enough forward to clear the tongue. Another error is applying pressure to the soft tissue beneath the chin, which can worsen the obstruction by pushing the tongue back. The rescuer must ensure their fingers are firmly positioned on the bony structure of the jaw at the mandibular angles.
Once the maneuver is performed, the rescuer must immediately check for successful air movement using the “look, listen, and feel” technique. This involves:
- Looking for the rise and fall of the chest.
- Listening for breath sounds.
- Feeling for the exhalation of air on the cheek.
If the airway remains blocked, the rescuer should reposition their hands and attempt the maneuver again, ensuring the jaw is thrust more aggressively forward. If the JTM fails and no other advanced airway adjuncts are available, the rescuer must consider using the head-tilt/chin-lift maneuver, as securing an open airway takes precedence over spinal precaution.