When a person becomes unconscious, one of the most immediate life-threatening concerns is the obstruction of the airway. This blockage occurs because the muscles relax, causing the tongue to fall backward and block the entrance to the windpipe, or trachea. Establishing a clear passage for air to the lungs is the first step in providing basic life support for an unresponsive individual who is not breathing normally. The method chosen depends on whether there is a suspicion of a neck or spinal injury.
The Standard Airway Opening Procedure
The most common and preferred method for opening the airway in a person without a suspected neck or spinal injury is the Head-Tilt/Chin-Lift (HTCL) maneuver. This technique works by using the leverage of the head and jaw to mechanically lift the tongue away from the back of the throat, thus clearing the obstruction. The procedure requires the rescuer to place one hand on the victim’s forehead and two fingers of the other hand on the bony part of the chin.
Applying a gentle, backward pressure on the forehead simultaneously tilts the head back, while lifting the chin elevates the lower jaw. This combined action extends the neck, moving the tongue and soft palate forward to create an open pathway for air. It is important to avoid pressing on the soft tissue under the chin, which could inadvertently compress the airway and worsen the obstruction.
The HTCL maneuver requires modifications when applied to different age groups. For an adult, the head is tilted fully back. Children require a less aggressive tilt, often described as the “sniffing position,” which aligns the airway without overextending the neck. For infants, the head should only be moved into a neutral position, as excessive tilting can actually cause the pliable airway to kink and close.
The Necessary Alternative for Spinal Safety
When a victim has experienced trauma (such as a fall, car accident, or diving injury), there is potential for a neck or cervical spine injury. The Head-Tilt/Chin-Lift maneuver is avoided because tilting the head backward could cause movement of damaged vertebrae, risking permanent neurological damage. The alternative technique is the Jaw-Thrust maneuver, designed to open the airway while maintaining the neck in a neutral, in-line position.
The Jaw-Thrust maneuver is performed from the top of the victim’s head. The rescuer places their index and middle fingers on the angles of the victim’s lower jaw (mandible) on both sides. The jaw is then grasped and gently thrust forward and upward without tilting or rotating the head. This forward displacement pulls the tongue and epiglottis clear of the airway.
While the Jaw-Thrust is the preferred method when spinal injury is suspected, it is more difficult to perform correctly and maintain, especially for a single rescuer. The goal is to move the jaw enough to clear the airway while ensuring the neck remains stable, minimizing movement in the C1 and C2 vertebrae area. This technique is crucial for prioritizing cervical spine stability.
Assessing Breathing and Immediate Actions
Once the airway is opened, the next step is to quickly determine if the victim is breathing normally. The standard assessment method is the “Look, Listen, and Feel” technique, which must be completed within a maximum of ten seconds. The rescuer should maintain the open airway while observing the chest for rise and fall.
Simultaneously, the rescuer places an ear close to the victim’s mouth and nose to listen for the sound of breathing and feel for the flow of air against their cheek. If the person is breathing normally, they should be placed into a recovery position to maintain the open airway and prevent aspiration, while emergency services are contacted. Breathing that is infrequent, noisy, or characterized by irregular gasps should not be considered normal.
If the assessment reveals that the victim is not breathing normally, or not breathing at all, immediate action is required to provide ventilation. The rescuer must transition to providing rescue breaths and chest compressions, following the guidelines for Cardiopulmonary Resuscitation (CPR). The open airway must be maintained throughout resuscitation to ensure air delivered during rescue breaths reaches the lungs.