to cough. If the patient is unable to cough, begin to
treat the patient as if this were a complete obstruction.
(This also applies to patients who are cyanotic.)
Complete Airway Obstruction
Conscious patients will attempt to speak but will
be unable to do so. Nor will they be able to cough.
Usually, patients will display the universal distress
signal for choking by clutching their neck.
unconscious patient with a complete airway
obstruction exhibits none of the usual signs of
breathing: rise and fall of the chest and air exchange
through the nose and/or mouth. A complete blockage
is also indicated if a correctly executed attempt to
perform artificial ventilation fails to instill air into the
Opening the Airway
Many problems of airway obstruction, particularly
those caused by the tongue, can be corrected simply by
repositioning the head and neck. If repositioning does
not alleviate the problem, more aggressive measures
must be taken.
POSITIONING THE PATIENT.When a
patient is unresponsive, you must determine if he is
breathing. This assessment requires the patient to be
positioned properly with the airway opened.
Before repositioning patients, it is imperative that
you remember to check them for possible spinal
injuries. If there is no time to immobilize these injuries
and the airway cannot be opened with the victim in the
present position, then great care must be taken when
The head, neck, and back must be
moved as a single unit. To do this, adhere to the
following four steps (see figure 4-2).
Step 1Kneel to the side of the victim in line with
the victims shoulders, but far enough away so that the
victims body will not touch yours when it is rolled
toward you. Straighten the victims legs, gently but
quickly. Then move the victims closer arm along the
floor until it reaches straight out past the head.
Step 2Support the back of the victims head with
one hand while you reach over with the other hand to
grasp under the distant armpit.
Step 3Pull the patient toward you while at the
same time keeping the head and neck in a natural
straight line with the back. Resting the head on the
extended arm will help you in this critical task.
Step 4Roll the patient onto his back and
reposition the extended arm.
Once the patient is supine with the arms alongside
the body, you should position yourself at the patients
side. By positioning yourself at the patients side, you
can more easily assess whether the patient is breathing.
If the patient is not breathing, you are already
positioned to perform artificial respirations (also
referred to as rescue breathing) and chest com-
Either one of two maneuversthe head tilt-chin
lift maneuver or the jaw-thrust maneuvermay be
used to open an obstructed airway. When performing
these maneuvers, you may discover foreign material or
vomitus in the mouth that needs to be removed. Do not
spend very much time to perform this task. Liquids or
semiliquids should be wiped out with the index and
middle finger covered by a piece of cloth.
material should be extracted with a hooked index
HEAD TILT-CHIN LIFT MANEUVER.The
head tilt-chin lift maneuver is the primary method used
to open the airway. To perform the head tilt-chin lift
maneuver, place one of your hands on the patients
forehead and apply gentle, firm, backward pressure
using the palm of your hand. Place the fingers of the
other hand under the bony part of the chin. Lift the chin
forward and support the jaw, helping to tilt the head
back. See figure 4-3. This maneuver will lift the
patients tongue away from the back of the throat and
provide an adequate airway.
When performing the
head tilt-chin lift maneuver, do not press too
deeply into the soft tissue under the chin.
Undue pressure in this location may obstruct
the airway. In addition, make sure the mouth is
kept open so exhalation and inhalation are not
JAW-THRUST MANEUVER.The jaw-thrust
maneuver is considered an alternate method for
opening the airway. This maneuver is accomplished by
kneeling near the top of the victims head, grasping the
angles of the patients lower jaw, and lifting with both
hands, one on each side.
This will displace the
mandible (jawbone) forward while tilting the head
Figure 4-4 illustrates the jaw-thrust
maneuver. If the lips close, retract the lower lip with
your thumb. If mouth-to-mouth breathing is necessary,
close the nostrils by placing your cheek tightly against