Paramedic’s Corner: Opening airway to get unconscious patients breathing
By: Ambulance Director Gary Carmack
Posted: Friday, November 20, 2009 3:43 am
Ambulance Director Gary Carmack
The infamous bank robber, Willie Sutton, was once asked why he always robbed banks. His alleged reply: “Because that’s where the money is,” led to the often quoted adage: “Go where the money is.”
In the world of emergency medical care, “the money” is often in the patient’s respiratory system, or more specifically in the airway and breathing.
The primary focus of this article is a detailed “how to” open the airway of an unconscious person. Often a life hangs in the balance of the availability and/or ability of an individual being present to open the airway of a comatose person.
A quick story to relate the importance of airway care: I responded to a call one day out on Interstate 44 reporting that a man was laying in the middle of the road. A person had stopped to help. She, with good intentions, had the man’s head laying on a pillow in her lap. The man was cyanotic (blue skin color) and had snoring respirations made by the tongue partially blocking the airway due to the position of his head on her lap. His airway was blocked and he was literally dying.
With one simple movement, I repositioned his head and opened the airway. Air could be heard entering his lungs and the cyanosis quickly dissipated. The man was unconscious from a head injury, but with just his airway and breathing being corrected, he lived and did well.
A little anatomy is needed to understand opening the airway.
The tongue is a muscular organ with the primary functions of (1) mechanical processing, (2) manipulation to assist in chewing and swallowing, and (3) sensory analysis. This organ attaches to the mandible (the lower jaw bone), and that is where the potential for problems lies. The mandible is movable, thus in a stuporous or comatose patient the jaw relaxes allowing the tongue to fall back against the posterior wall of the pharynx (throat) and block the airway. A person whose airway is partially obstructed will have snoring respiration, which sounds the same as when your spouse snores at night.
A person whose airway is completely blocked will have no respirations at all — a very deadly situation. Fortunately, obstruction of the airway by the tongue, which by the way, is the most common cause of airway obstruction, is a very simple problem to fix by using one of several maneuvers that elevate the base of the tongue away from the back of the throat.
The simplest method is called the head tilt. To do this maneuver is so simple that it is a mystery why people die from airway obstruction when often dozens of people are standing nearby.
This is how to do the head tilt: place one hand on the victim’s forehead and apply firm pressure backward with the palm. This alone brings the mandible forward and opens the airway.
The better maneuver is the head tilt-chin lift. To do this, do the aforementioned head tilt by placing the hand on the forehead and apply pressure. Then, take the fingers of the other hand and place them under the bony part of the victim’s chin and lift plus pull forward on the chin. This maneuver supports the jaw as well helps tilt the head.
Do not push the head forward (flexion) as this blocks the airway, and also is a very dangerous position if the spinal column has been damaged. Flexing the head forward is more likely to cut the spinal cord. If you get confused, just remember the pillow incident on the interstate. The pillow brought the head forward (flexion) which should not be done. When I removed the pillow, the head went back, opening the airway. Also, the head should not be moved to the left or right if there is possible spine injury.
Can tilting the head back be dangerous if a cervical spine injury is present? Yes. But the alternative is death if the victim is not breathing. If you believe the victim might have a cervical spine injury you can do a jaw thrust, rather then the head tilt.
To do a jaw thrust, take the fingers on both hands and place them on the angles of the victim’s jaw with the head in a neutral position. This moves the jaw forward, again moving the tongue forward out of the airway. This maneuver requires a little more training, but is safer in the trauma patient with possible cervical spine injury.
Any readers wanting to learn these maneuvers by practicing on a manikin can contact the Pulaski County Ambulance District for CPR instructions, or attend EMT school at PCAD or any state-accredited EMT school.