An unresponsive victim does not move, speak, or react when stimulated. The immediate priority for any rescuer is to establish an open airway, as a clear passage for air is the first step in resuscitation. Rapid intervention can prevent brain injury, which can begin within four to six minutes of oxygen deprivation. The technique employed is a mechanical action designed to physically move structures blocking the flow of air into the lungs.
The Need for Airway Management
When a person becomes unresponsive, the body’s muscles relax completely, including those in the throat. This loss of muscle tone allows the tongue, which is attached to the lower jaw, to fall backward against the posterior wall of the pharynx. The tongue is the most common cause of airway obstruction in an unconscious person lying on their back. This mechanical obstruction necessitates a physical maneuver to manually lift the tongue and soft palate away from the back of the throat.
Standard Airway Opening Technique
The preferred method for opening the airway of an unresponsive adult or child without a suspected spinal injury is the Head-Tilt/Chin-Lift maneuver. This technique is highly effective, leveraging the connection between the tongue and the jaw to clear the obstruction. To begin, the rescuer should kneel beside the victim’s head and place the heel of one hand on the center of the victim’s forehead.
The goal is to apply firm, backward pressure to tilt the head back, stretching the front neck muscles. Simultaneously, the index and middle fingers of the other hand are placed under the bony part of the victim’s chin. The rescuer then lifts the chin upward and forward, mechanically pulling the tongue away from the pharynx. Avoid pressing on the soft tissue under the chin, as this could compress the airway.
The combination of tilting the head and lifting the chin repositions the lower jaw and tongue, creating a straight path for air. This maneuver should be used for all non-trauma cases, such such as cardiac arrest. This technique involves moving the neck and must be avoided if there is any suspicion of trauma to the head, neck, or back. If the initial attempt does not open the airway, the rescuer should adjust the head position slightly and try again.
Alternative Technique for Spinal Injury
When an unresponsive victim is found following potential trauma—such as a car accident or a fall—the risk of a spinal cord injury must be assumed. Moving the head and neck, as required by the Head-Tilt/Chin-Lift, could cause further injury to the spinal cord. The alternative technique that minimizes cervical spine movement is the Jaw-Thrust maneuver.
To perform the Jaw-Thrust, the rescuer should kneel at the top of the victim’s head, placing one hand on each side of the face. The index and middle fingers are placed under the angles of the lower jaw, just below the ears. The rescuer then uses their fingers to firmly thrust the jaw forward and upward. This action causes the lower jaw to protrude, lifting the tongue away from the back of the throat while keeping the neck in a neutral, in-line position.
Next Steps: Verifying Airway Patency
Once the airway is opened, the immediate next step is to determine if the victim is breathing normally. The rescuer should maintain the open airway position and quickly check for signs of breathing for no more than ten seconds. This assessment focuses on looking for chest movement, listening for breath sounds, and feeling for air movement.
If the victim is breathing normally, the rescuer should place them in the recovery position, provided no spinal injury is suspected. The recovery position involves carefully turning the victim onto their side with the head supported. This helps keep the airway open and allows any fluids to drain safely from the mouth while waiting for professional medical help.
If the victim is not breathing, or is only exhibiting agonal gasps, the rescuer must immediately begin cardiopulmonary resuscitation (CPR). CPR involves cycles of chest compressions and rescue breaths, starting with compressions. The standard adult sequence involves 30 chest compressions followed by two rescue breaths. To deliver rescue breaths, the rescuer maintains the open airway, pinches the victim’s nose, and delivers a breath over one second, ensuring the chest rises. If the chest does not rise, the rescuer must re-establish the airway opening technique before attempting the second breath.