Resuscitation Guidelines

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Airway Management

Obstruction of the airway

An unconscious casualty has no control over his or her muscles, including the muscles that control the tongue. The relaxed tongue will fall backwards across the airway, and cause an obstruction. If a breathing unconscious casualty remains on his or her back, the risk of airway obstruction is increased.

An unconscious casualty may also have material in the mouth such as food, blood or vomitus, which may obstruct the airway. It is vital that if such material is present it is removed as soon as possible.

Ensuring an open Airway

Head Tilt/Chin Lift

Head tilt-chin lift manoeuvre is the primary method used to open the airway. To perform the head tilt-chin lift manoeuvre, place one of your hands on the patient’s 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. This manoeuvre will lift the patient’s tongue away from the back of the throat and provide an adequate airway.

Jaw Thrust

The jaw-thrust manoeuvre is considered an alternate method for opening the airway. This manoeuvre is accomplished by kneeling near the top of the victim’s head, grasping the angles of the patient’s lower jaw, and lifting with both hands, one on each side. This will displace the mandible jawbone) forward while tilting the head backward.

Artificial Airways

Also known as airway adjuncts. 3 types are commonly used by technicians, these are:

Oro-Pharyngeal (OP)- are used to maintain the airway in the unconscious patient during bag and mask ventilation. They are:

Inserting an Oro Pharyngeal

At all times the patient's airway is maintained by the hand not holding the device: holding the mouth open and jaw forward.

An oropharygneal airway is functionally-dependent upon getting the right size; measure from angle of mouth to ear and size the airway against this distance.

Airway Sizes

Inserting a Naso Pharyngeal

Naso-Pharyngeal (NP) - may be used on conscious victims since it is better tolerated because it generally does not stimulate the gag reflex. Since it is made of flexible material, it is designed to be lubricated and then gently passed up the nostril and down into the pharynx. If the airway meets an obstruction in one nostril, withdraw it and try to pass it up the other nostril.


Laryngeal Mask Airway (LMA) - is used for the purpose of airway management and sits tightly over the top of the larynx it is used as an alternative to Endotraceal Intubation (ET). Although used as an alternative it is believed that it is not as good at securing an airway as the ET route due to the fact it may not protect the airway from aspiration of vomitus. Some ambulance services allow a technician to use this form of adjunct to protect an airway whereas others may not due to the belief that theatre time is required to 'master' it's insertion, although it may be said that the experienced clinician can easily teach the inexperienced how to insert the LMA correctly.

Inserting the LMA:

  1. Insertion of an LMA (Link to External Site)

Image: mask airway.htm

Finger Sweep

Probably the simplist means for removing a foreign body can be done by performing a “finger sweep.” This procedure, however, must be performed on unconscious victims only (though not on patient having an epileptic seizure).

Suction - Used for removal of fluids in the mouth e.g. Blood or vomit

Back Slaps, Abdominal Thrusts - See procedure for a choking patient below

Choking Patient - Adult

If blockage of the airway is only partial, the victim will usually be able to clear it by coughing, but if obstruction is complete urgent intervention is required to prevent asphyxia.

Victim is conscious and breathing, despite evidence of obstruction:

Obstruction is complete or the victim shows signs of exhaustion or becomes cyanosed:

If the victim is conscious:

If the victim at any time becomes unconscious:

This may result in the relaxation of the muscles around the larynx (voicebox) and allow air to pass down into the lungs. If at any time the choking victim loses consciousness carry out basic life support:
Choking Patient - Child

There are a number of different foreign body obstruction sequences each of which has its advocates.

If the child is breathing spontaneously his own efforts to clear the obstruction should be encouraged. Intervention is necessary only if these attempts are clearly ineffective and breathing is inadequate.

1. Perform up to FIVE back blows

2. Perform up to FIVE chest thrusts

3. Check mouth

4. Open airway

5A. If the child is breathing

5B. If the child is not breathing:

For a child

For an infant

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Visit the European Resuscitation Council website for information on Basic Life Support. *Adult and Paediatric* (New window will open)