Manual Maneuvers
Chin lift/Head tilt:
Place the fingers of one hand on the protruding part of the chin below the lower jaw. Bring the chin forward by lifting. Meanwhile support the jaw and guide the head back.
Thrusting the jaw:
When choosing this method, always ensure that the neck is stabilized. Place both hands on either side of the neck and push up on the angles of the jaw using your fingers opening the airways. This option would be the appropriate method for trauma patients.
Airway Adjuncts:
Positioning a Nasopharyngeal Airway Tube:
- Choose a suitable size: the length of the tube should be equivalent to the length from the tip of the nose to the tragus of the ear. The diameter should be slightly smaller than the diameter of the nostrils.
- Make sure that the airway is lubricated.
- Introduce airway at a 45 degree angle towards the septum; press the tip forward adjacent to the floor of nasal cavity. While inserting, rotate the tube.
- Re-examine the airway.
Complications:
Gastric distention and hypoventilation will occur if the tube is too long and it enters the esophagus.
For use:
In patients that still have a gag reflex.
Positioning a Oropharyngeal Airway Tube:
- Establish a suitable size by calculating the distance from the midline of the lip to the angle of the jaw and from the earlobe to the corner of the mouth.
- Open the airway by using the chin lift or head tilt when dealing with medical patients, or the jaw thrust when dealing with trauma patients.
- Put pressure on the chin and use the thumb to open the mouth.
- Introduce the oropharyngeal airway tube by pointing the tip upward en route to the roof of mouth. Rotate the tube gently.
- Re-evaluate the airway.
Complications:
Complete airway obstruction will occur if the airway is too long as it may press the epiglottis against the entrance of the larynx.
For use:
In the unconscious patient without a gag reflex.
Bag-Valve-Mask
Bag-valve-mask ventilation procedure:
- Decide on the proper size of mask/bag that should be used.
- Open the airway by using the chin lift/head tilt when considering medical patients, or the jaw thrust when dealing with trauma patients.
- Introduce appropriate airway adjunct.
- Apply minor pressure on mask and secure the mask to the face; establish an adequate seal by using C-grip with one hand and by squeezing the bag with another.
Complications:
If a patient is not intubated you will not be able to provide adequate ventilatory volumes.
For use:
When ventilating patients in a pre-hospital setting.
Resource: LBFD Training Centre. Automatic External Defibrillation
