Airway Management

Airway management is required to provide an open airway when the person:

  • Is unconscious.
  • Has an obstructed airway.
  • Needs rescue breathing.

For unresponsive adults and children, it is reasonable to open the airway using the head tilt, chin lift manoeuvre.

Head Tilt/Chin Lift

One hand is placed on thOne hand is placed on the forehead or the top of the head. The other hand is used to provide chin lift. The head (NOT the neck) is tilted backwards (see Figure 1). It is important to avoid excessive force, especially where neck injury is suspected. When the person is on their side, the head will usually remain in this position when the rescuer’s hands are withdrawn.

Chin lift is commonly used in conjunction with backward head tilt. The chin is held up by the rescuer’s thumb and fingers in order to open the mouth and pull the tongue and soft tissues away from the back of the throat.

A suggested technique is to place the thumb over the chin, below the lip and supporting the tip of the jaw with the middle finger and the index finger lying along the jaw line. Be careful that the ring finger does not squash the soft tissues of the neck. The jaw is held open slightly and pulled away from the chest.

Children and Infants

An infant is defineAn infant is defined as younger than one year, a child as one to eighteen years of age (or up to onset of puberty if the age is unknown). In both cases the principle is to maintain an open airway.

Children

Children should be managed as for adults.

Infants

In an infant, the upper airway is easily obstructed because of the narrow nasal passages, the entrance to the windpipe (vocal cords) and the trachea (windpipe). The trachea is soft and pliable and may be distorted by excessive backward head tilt or jaw thrust. Therefore, in an infant the head should be kept neutral and maximum head tilt should not be used (Figure 2).

The lower jaw should be supported at the point of the chin while keeping the mouth open.

There must be no pressure on the soft tissues of the neck. If these manoeuvres do not provide a clear airway, the head may be tilted backwards very slightly with a gentle movement.