Establishing a patent airway is the most important action in any life-threatening emergency involving an unresponsive person. When consciousness is lost, the muscles in the jaw and throat relax, often causing the tongue to fall backward and obstruct the upper airway. This obstruction prevents effective breathing. A specific physical technique is necessary to reposition the structures and ensure a clear passage for air. The choice of maneuver depends entirely on whether a spinal injury is suspected.
The Primary Airway Maneuver
When no trauma or spinal injury is suspected, the standard and most effective method for opening the airway is the Head-Tilt, Chin-Lift maneuver. This technique is designed to move the tongue away from the posterior pharyngeal wall, clearing the obstruction. The rescuer begins by kneeling beside the person’s head and placing one hand gently on their forehead.
The next step involves applying pressure to the forehead to tilt the head backward, extending the neck slightly. Simultaneously, the fingers of the other hand are placed under the bony part of the chin, avoiding the soft tissue. The chin is then lifted upward, pulling the lower jaw and tongue forward, which opens the airway.
This combination repositions the head and neck to create a straight path for air to flow freely. The Head-Tilt, Chin-Lift is a rapid, non-invasive technique requiring no special equipment. It is the preferred method in scenarios like sudden cardiac arrest or non-traumatic unconsciousness. Maintaining this position is essential to keep the airway open while checking for breathing or delivering rescue breaths.
Recognizing Potential Spinal Trauma
Before initiating any airway maneuver, a rapid assessment must determine the potential for a neck or spinal injury, as moving the neck can cause severe harm. Suspicion should be maintained whenever the mechanism of injury suggests significant force was applied to the head, neck, or torso. These mechanisms include falls from a height, motor vehicle collisions, blunt trauma, or diving accidents.
Signs of a spinal injury include an altered level of consciousness, an oddly positioned head or neck, or complaints of severe neck or back pain. The person may also exhibit weakness, numbness, or paralysis in their limbs. If a spinal injury cannot be immediately ruled out, the traditional Head-Tilt, Chin-Lift maneuver is contraindicated due to the risk of exacerbating a vertebral injury.
The Airway Maneuver for Trauma Victims
When there is any indication of a possible neck or spinal injury, the Jaw Thrust Maneuver must be used to open the airway while minimizing movement of the cervical spine. This specialized technique stabilizes the head and neck in a neutral position while only moving the jaw forward. The rescuer positions themselves at the top of the person’s head and places their elbows on the ground for stability.
The rescuer then places their fingers under the angles of the person’s lower jaw on both sides, with their thumbs resting on the cheekbones. By applying upward and forward pressure, the jaw is displaced forward without tilting the head. This action lifts the tongue away from the back of the throat and opens the airway while maintaining manual in-line stabilization of the neck.
The Jaw Thrust Maneuver is technically more difficult to perform than the Head-Tilt, Chin-Lift and is often fatiguing to maintain. Its benefit is that it causes significantly less movement of the cervical vertebrae, reducing the risk of secondary spinal cord injury. If the Jaw Thrust Maneuver fails to open the airway, current guidelines suggest a gentle Head-Tilt, Chin-Lift may be attempted as a last resort, since establishing an open airway is paramount to life.