Airway manoeuvres

Procedure, instructions and discussion

Airway manoeuvres for upper airway obstruction (partial or complete)

Detailed written instructions and explanation are available in our Free App (iOS and Android). This video is hot off the press and we want your help improving it. Drop us a line with any suggestions

Instructions

Indications

• Upper airway obstruction (partial or complete)

Contraindications (ABSOLUTE/relative)

• None

Alternatives

• Oropharyngeal airway (OPA)
• Nasopharyngeal airway (NPA)
• Bag-Valve-Mask (BVM )Ventilation
• Supraglottic Airway Device intubation (SAD, LMA)

Informed consent

NOT REQUIRED

• Consent is not required. This is an emergency procedure to save a life

Potential complications

• Pain
• Failure to open airway

Infection control

• Standard precautions
• PPE: non-sterile gloves

Area

• Any

Staff

• Procedural clinician

Position

• Supine

Sequence

Head-tilt, Chin-lift

• Place one hand on the patient’s forehead and tilt the patients head backwards
• Lift the mandible at the mentum using index and middle fingertips (avoiding soft tissue compression)
• Simultaneously apply downward pressure to the patient’s forehead
• The thumb may be used to grip the chin aiding chin-lift and mouth opening

Jaw thrust

• Place index and middle fingertips behind angle of the mandible on each side
• Place the thenar eminence of each hand over the zygomatic arch
• Pull mandible anteriorly until lower incisors are anterior to upper incisors
• The thumb may be used to grip to aid mouth opening

Airway obstruction from fluid or matter

• Roll patient onto side, open mouth and turn head downwards to allow material to drain
• Manual C-spine immobilisation and open mouth if C-spine injury suspected
• Large-bore (more effective) or Yankauer (reduced trauma) suction of secretions
• Remove loose dentures but allow well-fitting dentures to remain

Post-procedure care

DOCUMENT PROCEDURE

• Definitive airway management if required

Tips

• Obese patients require increased head elevation (ramping) to achieve the sniffing position

Discussion

All airway manoeuvres are associated with some movement of the cervical spine. In suspected C-spine injury manual in-line stabilisation of the C-spine should be provided with jaw thrust preferred and chin-lift added only if jaw thrust fails. While we always try to protect the spine, it is important to remember opening the airway takes precedence over spinal or other injuries.

References

• Australian Resuscitation Council and New Zealand Resuscitation Council. ANZCOR guideline 4 – airway. Melbourne: Australian Resuscitation Council and New Zealand Resuscitation Council; 2016. 7pp. Available from https://resus.org.au/guidelines/
• Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.
• Wittels KA. Basic airway management in adults. In: UpToDate. Waltham (MA): UpToDate. 2019 Sept 17. Retrieved March 2019. Available from: https://www.uptodate.com/contents/basic-airway-management-in-adults
• Guildner CW. Resuscitation – opening the airway. A comparative study of techniques for opening an airway obstructed by the tongue. JACEP. 1976 Aug;5(8):588-90.

The App