A for Airway
The head-tilt chin-lift opens the airway safely and effectively.
The complex structures of the human body leading from the lips to the lungs are often referred to simply as the patient’s “airway”. The airway of the human body is one of the more important parts to be checked when providing first aid, and is typically the first item given attention in the seriously sick or injured patient. The airway is the entrance point of oxygen and the exit point of carbon dioxide for the body. Should this become blocked, the victim will have no way to obtain fresh air, and death will eventually result.
We are normally able to keep our airway a clear path for fresh air subconsciously. Depending on the severity of the victim’s condition, an unconscious person’s airway could be blocked when their tongue relaxes and falls across their throat, blocking airflow. A common example of this is the sounds made by a snoring person. The technique used to open the airway and keep the tongue out is referred to as the “head-tilt chin-lift” technique.
For this to work properly, the patient will be placed on a flat surface, lying on their back. Kneeling at the level of the victim (easiest when the rescuer is on one side of the injured individual) the rescuer places one palm, open handed, on the victim’s forehead. The rescuer then places the index and middle finger of their other hand under the bony part of the victim’s jaw (mandible). The fingers and palm are used to gently tilt the victim’s head backwards, and lift their chin upwards, extending the victim’s neck. Ideally, once you have done this, the victim’s jawline will be perpendicular to the ground allowing the airway to be open the maximum amount.
This technique is typically not necessary for conscious victims, as they can typically maintain an open airway. Simply, if the victim is talking or has no respiratory distress, their airway is adequate.
Even if you suspect that your victim may have sustained a spinal neck injury, open the airway as normal, but with caution. Life over limb – the potential for keeping the victim alive outweighs the risk of aggravating the spinal injury. If you absolutely must roll a person suspected of head, neck, or spinal injury because he or she is vomiting, choking on blood or in danger of further injury, use at least two people. Work together to keep the person’s head, neck and back aligned while rolling the person onto one side.
You may also check the victim’s mouth for visible, removable obstructions in the mouth which can obstruct airflow. The common items found obstructing the victim’s airway include partially chewed food, hard candy, and balloons. You may attempt to expel any items in the mouth which can be easily withdrawn with a finger swipe but do not waste time trying to remove fixed or lodged items such as dentures. Also, be alert to the status of your victim, as you could be injured if your fingers are in the mouth of a person regaining consciousness.
If a conscious victim’s airway is obstructed by a foreign object (such as someone who is choking), the object must be removed via other means. Abdominal thrusts are the standard method for conscious victims. Refer to Obstructed Airway for unconscious procedures.
Conscious Victims
A person may be choking if they:
- desperately grabbing at their neck
- cannot speak or cry out
- face turns blue from lack of oxygen
The initial action if you suspect choking is to clearly ask the victim “Are you choking?”
If the victim can reply verbally, you should not undertake any physical contact, but do encourage the victim to cough.
Treatment for adults and children
- Encourage the victim to cough – some victims are in so much panic they require encouragement to cough
- Deliver up to 5 hard blows with the heel of your hand to the centre of the victims back between the shoulder blades.
- If the object has still not been removed, and the victim is still choking, you should perform up to five abdominal thrusts.
- The rescuer stands behind and to the side of the victim and wraps their arms around the victim’s sides, underneath the victim’s arms
- One hand is made into a fist and placed, thumb side in, flat against the victim’s upper abdomen, below the ribs but above the navel
- The other hand grabs the fist and directs it in a series of upward thrusts until the object obstructing the airway is expelled
- The thrusts should not compress or restrict the ribcage in any way.
- If you’re not able to compress the victim’s diaphragm due to their size or pregnancy, then perform the thrusts at the chest.
- Continue a cycle of back blows and abdominal thrusts until the blockage is removed, or the victim becomes unconscious (see below for action when unconscious)
Abdominal thrusts are performed only on conscious adult or child victims with a severe airway obstruction
Note that even when performed correctly, abdominal thrusts can injure the person they are performed on, and so should always be used as a last resort after encouragement to cough and back blows. Abdominal thrusts should never be performed on someone who can still cough, breathe, or speak – encourage them to cough instead.