The Jaw Thrust Maneuver is a specialized, non-invasive technique used in emergency airway management to establish a clear passage for breathing in an unconscious person. It works by physically moving the lower jaw (mandible) forward and upward. This action mechanically pulls the tongue and soft tissues away from the back of the throat, relieving the obstruction and allowing air to flow freely.
When to Choose the Jaw Thrust Maneuver
The Jaw Thrust Maneuver is specifically indicated when there is a suspicion of cervical spine (neck) injury in an unconscious patient. This concern often arises following high-impact events such as motor vehicle accidents, significant falls, or diving incidents. In these scenarios, minimizing head movement is a top priority, as any movement of the head or neck can potentially worsen an existing spinal cord injury.
The more common method for opening an airway is the Head-Tilt/Chin-Lift maneuver, but that technique involves tilting the head backward, moving the neck vertebrae. Performing the Head-Tilt/Chin-Lift when a neck injury is suspected introduces an unacceptable risk of secondary neurological damage. The Jaw Thrust is selected because it opens the airway by manipulating only the jaw, keeping the head and cervical spine in a neutral, stable alignment. This ensures life-saving airway management while maintaining spinal precautions.
Detailed Execution of the Procedure
To begin the Jaw Thrust Maneuver, the rescuer should kneel at the patient’s head, ensuring the patient is lying supine on a firm, flat surface. This positioning allows the rescuer to stabilize the head and maintain the neutral alignment of the neck. The rescuer then places the index and middle fingers of both hands behind the angles of the patient’s lower jaw, near the earlobes, resting the thumbs on the cheekbones or chin for stability.
With the fingers positioned at the bony angles of the mandible, the rescuer applies a firm, upward, and forward pressure. This action is a physical thrust that displaces the lower jaw anteriorly, which in turn lifts the tongue base from the posterior pharynx. The goal is to move the lower teeth in front of the upper teeth, or at least to a point where the airway opens, without causing any extension or rotation of the patient’s neck.
The rescuer must maintain upward and forward pressure with the fingers to keep the airway open. Because the maneuver can be physically taxing, the rescuer should use the heels of the hands or forearms to stabilize the patient’s head and prevent lateral movement. Successful execution is confirmed when the rescuer observes or feels signs of air movement, such as visible chest rise or breath sounds.
Ensuring a Clear Airway: Troubleshooting
The Jaw Thrust Maneuver is technically more challenging to perform than the Head-Tilt/Chin-Lift and often requires significant muscular force, which can lead to rescuer fatigue. If the initial thrust is not successful in opening the airway, the rescuer should slightly adjust the position of the fingers and increase the upward and forward pressure on the mandible. It is important to continue this gentle repositioning while strictly avoiding any movement of the patient’s head or neck.
A common difficulty is encountering a stiff or tightly clamped jaw, which prevents the necessary forward displacement of the mandible. If the jaw cannot be moved forward, the maneuver is ineffective, and the rescuer must consider alternative advanced airway techniques if breathing is critically compromised. If the patient is wearing dentures, they should generally be left in place, as they provide structural support and assist with a better seal if mask ventilation is required.
If the dentures are loose or clearly blocking the airway, they must be removed to prevent obstruction. Immediately after successfully performing the Jaw Thrust and opening the airway, the rescuer must reassess the patient’s breathing status by looking for chest movement and listening for air flow. The maneuver must be sustained until the patient regains consciousness or until a more definitive airway device can be inserted by trained medical personnel.