Basic Airway Management Techniques

head-tilt chin-lift

1. Place one hand on the patient’s forehead and the fingertips of your other hand under the bony part of the chin.

2. Tilt the head back while lifting the chin.

This maneuver lifts the tongue away from the back of the throat, clearing the airway.

Remember, this technique is not used if you suspect a cervical spine injury.

jaw-thrust maneuver

used when you suspect a cervical spine injury.

1. place your hands on either side of the patient’s face, with your fingers behind the angle of the jaw,

lift the jaw forward. It can be helpful to brace your thumbs on their cheek bones. 

This technique opens the airway while maintaining neutral spine alignment. It’s more difficult to perform than the head-tilt chin-lift but is crucial in trauma situations.

recovery position

used for unconscious patients who are breathing adequately. It helps maintain an open airway and allows fluids to drain from the mouth.

To place a patient in this position,

1. kneel beside them and bend their nearest arm at a right angle.

2. Bring their far arm across their chest, bend their far leg and use it to roll them onto their side.

3. Adjust the upper leg for stability and tilt the head back slightly to keep the airway open.

Suctioning

crucial for removing fluids or debris from the airway. Use a portable suction unit with a rigid Yankauer tip for the mouth and a flexible catheter for the nose or tracheostomy. When suctioning, don’t suction for more than 15 seconds at a time, as this can deprive the patient of oxygen. Use a circular motion when suctioning the mouth. For nasopharyngeal suctioning, measure from the nose to the earlobe to determine safe insertion depth.

nasal cannula

low-flow oxygen device that delivers oxygen directly into the nostrils. It’s comfortable for the patient and allows them to speak and eat. Place the prongs in the nostrils and loop the tubing over the ears, and tuck the adjustment slider under their chin. Typical flow rates are 1-6 liters per minute, delivering 24-44% oxygen. It’s suitable for patients requiring low to moderate oxygen supplementation.

A simple face mask

covers the nose and mouth, delivering higher oxygen concentrations than a nasal cannula. It should fit snugly but comfortably. Typical flow rates are 6-10 liters per minute, delivering 40-60% oxygen. Ensure the flow rate is at least 6 liters per minute to prevent carbon dioxide buildup in the mask.

These masks are not common in EMS, and services typically only carry Non-Rebreather Masks, which we will cover next, but you will encounter these in the home care and nursing home settings.

non-rebreather mask

delivers the highest oxygen concentration of these three devices. It has a reservoir bag and one-way valves to prevent exhaled air from mixing with the oxygen supply. Set the flow rate to at least 10-15 liters per minute and ensure the reservoir bag is always at least partially inflated. This can deliver up to 95% oxygen and is used for patients with severe respiratory distress or hypoxia.

Choosing the right oxygen delivery method

Nasal cannulas are suitable for stable patients needing low to moderate oxygen. Simple face masks are used for patients needing moderate oxygen levels. Non-rebreather masks are for patients with severe respiratory distress or significant hypoxia. Always assess the patient’s response to oxygen therapy and be prepared to adjust or escalate treatment as needed.

oropharyngeal airway

OPA, is used to maintain an open airway in unconscious patients.

Two types of OPAs out there. One has a channel on each side. These are called Berman airways. You also have, OPS that have a hole in it These are known as Guedel Airways Which one you use doesn’t matter

1. choose appropriate size OPA, measure from the corner of the patient’s mouth to the tip of the ear.

2. open the airway using a cross-finger technique, scissor technique

3. insert the airway tip towards the roof of the mouth

4. You’re going slide it forward

5. Once you reach the crest of the tongue, you’re going rotate the OPA 180 degrees.

6. The flange of the OPA should then sit on the patient’s lips.

nasopharyngeal airway, NPA

more tolerable in semi-conscious patients

1. Size the NPA by measuring from the tip of the nose to the earlobe

2. Lubricate the NPA and insert it gently into the larger nostril, following the natural curve of the nasal passage. If you meet resistance, try the other nostril.

NPAs are contraindicated in patients with suspected skull base fractures.