Opening the Airway

KEY POINTS

  • An ‘open airway’ is one where the casualty is talking or breathing easily
  • A closed airway is one where there is snoring, gurgling or no breath sounds at all
  • Open the airway with a jaw thrust or ‘head tilt, chin lift’

EXPLANATION

An ‘open’ airway is one where air can get from the outside to the lungs. Airways become ‘closed’ when obstructed with blood, vomit or a foreign object, or when a casualty becomes unconscious and the soft tissues of their throat close over.

Kneel down at the level of the casualty. The airway is open if the casualty is talking or if air is moving in and out quietly and easily with each breath. It is closed if there is gurgling, snoring or no sound / air movement at all. In the outdoors, you need to use all your senses to assess the airway: look for chest wall movement, listen for breath sounds, and feel for air coming in and out of the casualty’s mouth with your palm or your cheek.

To open a closed airway, first remove anything obviously obstructing it. Do not put your finger blindly into the casualty’s throat.

Then, perform a ‘head tilt, chin lift’:

  1. Place one hand on the casualty’s forehead
  2. Place the other hand on the bony tip of the casualty’s chin
  3. Gently tilt the head back, while lifting the chin and allowing the mouth to fall open

If that is insufficient, or you don’t want to move the casualty’s neck, then perform a ‘jaw thrust’:

  1. Place your fingertips at the angle of the jaw
  2. Rest the base of your thumbs on the casaulty’s cheek bones
  3. Lift the jaw towards the sky

Both these manoeuvres help pull the soft tissues away from the back of the throat, opening the airway. The jaw thrust is usually the more effective of the two, however it is tiring and the jaw needs to be held constantly in position for the airway to remain open.

Sometimes, both the ‘head tilt, chin lift’ and the ‘jaw thrust’ are required.

Remember that airways are dynamic: they require constant monitoring and adjustment as a casualty’s clinical condition changes.