SuctionUnconscious patients are vulnerable to aspiration:
Use a wide bore rigid sucker and gentle suction under direct vision to remove potential aspirates (see image)
Learning Bite If the patient is actively vomiting or if there is a significant amount of blood in the airway, turn the patient on their side and tip the trolley head down to avoid aspiration. (Not an option in c-spine injury) Learning Bite If there are thick secretions or undigested food, remove the suction catheter and just use the tube to avoid blockage. Chin-lift manoeuvreUnconscious patients lying supine are vulnerable to airway obstruction because the oral axis (OA), pharyngeal axis (PA) and laryngeal axis (LA) are misaligned (Fig 3). Placement of a pillow or folded blanket beneath the head flexes the neck in relation to the torso (Fig 4). A chin-lift manoeuvre extends the head in relation to the neck and achieves the sniffing position (Fig 5). Both manoeuvres in combination improve axes alignment. If the patient is breathing adequately, a high-flow oxygen mask can be applied. Fig 3  Malalignment of the oral, pharyngeal and laryngeal axes in a patient in the supine position. Fig 4 Malalignment of the oral, pharyngeal and laryngeal axes in a patient in the supine position, and modification of alignment of axes, following placement of a pillow or folded blanket beneath the head. Fig 5 Learning Bite Beware hyperextension of the neck with the chin-lift manoeuvre because it can further compromise the airway. Gentle movement is advised in patients with fixed neck deformities. The chin-lift manoeuvre – obese patientsIn obese patients, standard pillow placement may compromise the airway further by causing flexion of the head in relation to the neck. To optimise an obese patients airway, place a pillow under their shoulders and a number of pillows under their head to elevate the chin above the chest (See Figure 6 & 7). The jaw thrustThe jaw thrust lifts the mandible forwards and lifts the tongue off the posterior pharynx. The manoeuvre is used for patients who require bag-mask ventilation (see image). The jaw thrust technique should be practiced in the clinical environment. It is achieved by hooking the little fingers underneath the angle of the jaw. Using the ring and middle fingers to secure grip under the mandible. Using the index finger and thumb to secure a tight seal between a mask and the face. Holding this position may become tiring. Learning Bite In trauma patients with suspected cervical spine injury, the jaw-thrust should be used instead of the chin-lift because movement of the head and neck is contraindicated. In an unconscious patient, the most common cause of airway obstruction is the tongue. To alleviate the obstruction and open the airway, a simple maneuver such as the Head-Tilt/Chin-Lift Maneuver can be performed. Alternatively, a Jaw Thrust maneuver can be used if there is concern that a C-spine injury may be present. If someone is injured in an incident, first check that you and the person who is injured are not in any danger. If you are, make the situation safe. When it's safe to do so, assess the person who is injured and, if necessary, dial 999 for an ambulance. You can then carry out basic first aid. Assessing an injured personThe 3 priorities when dealing with a casualty are commonly referred to as ABC, which stands for:
AirwayIf the person appears unresponsive, ask them loudly if they're OK and if they can open their eyes. If they respond, you can leave them in the position they're in until help arrives. While you wait, keep checking their breathing, pulse and level of response:
If there's no response, leave the person in the position they're in and open their airway. If this is not possible in the position they're in, gently lay them on their back and then try to open their airway. To open the airway, place 1 hand on the person's forehead and gently tilt their head back, lifting the tip of the chin using 2 fingers. This moves the tongue away from the back of the throat. Don't push on the floor of the mouth, as this will push the tongue upwards and obstruct the airway. If you think the person may have a spinal injury, place your hands on either side of their head and use your fingertips to gently lift the angle of the jaw forward and upwards, without moving the head, to open the airway. Take care not to move the person's neck. But opening the airway takes priority over a neck injury. This is known as the jaw thrust technique. BreathingTo check if a person is still breathing:
If they're breathing normally, place them in the recovery position so their airway remains clear of obstructions, and continue to monitor normal breathing. Gasping or irregular breathing is not normal breathing. If the person isn't breathing or is not breathing normally, call 999 for an ambulance and then begin CPR. CirculationIf the person isn't breathing normally, you must start chest compressions immediately. Agonal breathing is common in the first few minutes after a sudden cardiac arrest (when the heart stops beating). Agonal breathing is sudden, irregular gasps of breath. This shouldn't be mistaken for normal breathing and CPR should be given straight away. If the person isn't breathing, call 999 for an ambulance and then begin CPR. First aid coursesThe advice given on this page only covers common first aid situations and is not a replacement for taking a first aid training course. Basic first aid courses are run regularly in most areas around the UK. Organisations that offer courses include:
Page last reviewed: 15 March 2022 |
