2-4. Opening the Airway of an Unconscious or Not Breathing Casualty

Table of Contents

The tongue is the single most common cause of an airway obstruction (Figure 2-2). In most cases, simply using the head-tilt/chin-lift technique can clear the airway. This action pulls the tongue away from the air passage in the throat (Figure 2-3).

Figure 2-2. Airway blocked by tongue.

Figure 2-3. Airway opened by extending neck.

• a. Call for help and then position the casualty. Move (roll) the casualty onto his back (Figure 2-1C). (Refer to paragraph 2-3c for information on positioning the casualty.)

• NOTE

  Perform finger sweep. If foreign material or vomitus is visible in the mouth, it should be removed, but do not spend an excessive amount of time doing so.

• b. Open the airway using the jaw-thrust or head-tilt/chin-lift technique.

CAUTION

The head-tilt/chin-lift technique is an important procedure in opening the airway; however, use extreme care because excess force in performing this maneuver may cause further spinal injury. In a casualty with a suspected neck injury or severe head trauma, the safest approach to opening the airway is the jaw-thrust technique because in most cases it can be accomplished without extending the neck.

• • (1) Perform the jaw-thrust technique. The jaw-thrust may be accomplished by the rescuer grasping the angles of the casualty’s lower jaw and lifting with both hands, one on each side, displacing the jaw forward and up (Figure 2-4). The rescuer’s elbows should rest on the surface on which the casualty is lying. If the lips close, the lower lip can be retracted with the thumb. If mouth-to-mouth breathing is necessary, close the nostrils by placing your cheek tightly against them. The head should be carefully supported without tilting it backwards or turning it from side to side. If this is unsuccessful, the head should be tilted back very slightly. The jaw-thrust is the safest first approach to opening the airway of a casualty who has a suspected neck injury because in most cases it can be accomplished without extending the neck.

Figure 2-4. Jaw-thrust technique of opening airway.

• • (2) Perform the head-tilt/chin-lift technique. Place one hand on the casualty’s forehead and apply firm, backward pressure with the palm to tilt the head back. Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward. The thumb should not be used to lift the chin (Figure 2-5).

NOTE

The fingers should not press deeply into the soft tissue under the chin because the airway may be obstructed.

Figure 2-5. Head-tilt/chin-lift technique of opening airway.

• • (3) Check for breathing (while maintaining an airway). After establishing an open airway, it is important to maintain that airway in an open position. Often the act of just opening and maintaining the airway will allow the casualty to breathe properly. Once the rescuer uses one of the techniques to open the airway (jaw-thrust or head-tilt/chin-lift), he should maintain that head position to keep the airway open. Failure to maintain the open airway will prevent the casualty from receiving an adequate supply of oxygen. Therefore, while maintaining an open airway the rescuer should check for breathing by observing the casualty’s chest and performing the following actions within 3 to 5 seconds:
  • • (a) LOOK for the chest to rise and fall.
    • (b) LISTEN for air escaping during exhalation by placing your ear near the casualty’s mouth.
    • (c) FEEL for the flow of air on your cheek (see Figure 2-6).
    • (d) PERFORM rescue breathing if the casualty does not resume breathing spontaneously.

NOTE

If the casualty resumes breathing, monitor and maintain the open airway. He should be transported to an MTF, as soon as practical.