Patients who are not alert and not talking to you may have an obstructed airway.

When your patient is alert and speaking to you, checking the airway is unnecessary (it is impossible to speak through an obstructed airway). When the patient is not alert (and definitely not speaking), you have to assess the airway to determine if it is clear or not. The first step in assessing the airway in an unresponsive patient is to open the airway. Think of opening the airway like opening a door. For most patients, opening the airway is easy with the head tilt chin lift.

Place one hand on the victim’s forehead, and two fingers on the bony part of the jaw.  Gently tilt the head backward.  This will open the airway and lift the tongue off the back of the throat.  Carefully lean over the victim and look, listen, and feel for breathing.

When the patient has a broken neck, the head tilt chin lift movement will create tension on fractured vertebrae of the neck causing them to move, and damage the spinal cord. We would suspect a fracture of the vertebrae anytime we respond to an accident where there is a serious mechanism of injury. The mechanism of injury would give us insight as to the likelihood that the patient has broken their neck.

If the suspicion of a broken neck exists, and we need to open the airway because the patient is not alert or talking, then the method of opening the airway becomes the jaw thrust maneuver. The maneuver is used on a supine patient. It is performed by placing the index and middle fingers to physically push the posterior aspects of the lower jaw upwards while their thumbs push down on the chin to open the mouth. When the mandible is displaced forward, it pulls the tongue forward and prevents it from obstructing the entrance to the trachea.

When the patient requires the jaw thrust to open the airway, and also needs to be ventilated, the modified chin lift or ‘thumbs down’ method is used to create a seal between the patient’s face and a bag valve mask.