How do you access a patient's airway?

Airway Management Approach

To access a patient's airway, first perform a head tilt-chin lift maneuver by placing one hand on the forehead to tilt the head back while using two fingertips under the bony part of the chin to lift it upward. 1

Initial Assessment and Basic Airway Opening

• Assess the scene for safety before approaching the patient to ensure no hazards exist (such as electrical dangers) 1
• Check responsiveness by gently shaking the patient's shoulders while asking loudly, "Are you all right?" 1
• If unresponsive, call for help or send someone to call emergency services 1
• Open the airway using head tilt-chin lift:
  • Place one hand on the patient's forehead and gently tilt the head back
  • Place 2 fingertips under the point of the patient's chin (on the bone) and gently lift upward 1
• Remove any visible obstructions from the mouth (such as dislodged dentures) 1
• For suspected cervical spine injury, use a jaw thrust without head extension instead 1

Assess Breathing

• Maintain the open airway position while checking for breathing using the "look, listen, and feel" method:
  • Look for chest movement
  • Listen at the mouth for breath sounds
  • Feel for breath with your cheek 1
• Perform this assessment for no more than 10 seconds 1
• Treat a patient with occasional gasps as if they are not breathing 1

Rescue Breathing Technique

• If breathing is inadequate or absent:
  • Maintain head tilt-chin lift position
  • Pinch the nostrils closed with the thumb and index finger of the hand on the forehead
  • Create a complete seal around the patient's mouth with your mouth 1
  • Deliver two effective rescue breaths, each over 1 second 1
  • Each breath should be sufficient to cause visible chest rise (approximately 500-600 mL or 6-7 mL/kg) 1
  • Allow for exhalation between breaths 1
• Attempt no more than 5 times to achieve 2 effective breaths 1

Special Circumstances

• For mouth-to-nose ventilation (when mouth ventilation is impossible):
  • Create a seal over the nose instead of the mouth
  • Close the patient's mouth to prevent air leakage 1
• For patients with tracheostomy:
  • Remove any attachments to the tube (humidifiers, speaking valves) 1
  • If inner tube is present, remove and check for blockage 1
  • Pass a suction catheter to check tube patency and clear secretions 1
  • If tube is blocked and cannot be cleared, deflate the cuff (if present) to allow airflow past the tube 1
  • If still obstructed, remove the tracheostomy tube as it offers no benefit 1
  • Oxygen can be applied to both the stoma and face while awaiting expert assistance 2

Advanced Airway Management

• For healthcare providers, after initial rescue breaths, check for signs of circulation by looking, listening, and feeling for breathing while scanning for signs of movement 1
• If no signs of circulation, begin chest compressions and continue CPR 1
• For difficult airways, consider advanced techniques based on provider skill level and available equipment 1

Common Pitfalls to Avoid

• Do not shake the patient violently as this could cause head or cervical spine injuries 1
• Avoid excessive ventilation (too many breaths or too large volumes) during CPR 1
• Never attempt vigorous ventilation through a potentially displaced tracheostomy tube as this can cause surgical emphysema 1, 2
• Do not delay removing a blocked tracheostomy tube in a deteriorating patient 1
• Do not force any airway device against resistance as this may create a false passage 2