Basic Airway Management
Effective airway management is the immediate priority in any resuscitation. The primary goal is to restore and maintain a patent airway to permit oxygenation and ventilation.
In the emergency setting this is achieved first with simple positional manoeuvres and suction, progressing rapidly to adjuncts (OPA/NPA) or supraglottic devices (LMA/SGA) as required.
Definitive airway intervention (drug‑assisted rapid sequence intubation or surgical airway) is indicated when simple measures fail, especially in major trauma (NICE NG39; Resuscitation Council UK).
Principles and priorities
- Airway takes precedence in the ABCDE assessment: identify and treat life‑threatening obstruction immediately (Resuscitation Council UK).
- Use the least invasive effective measure first, but escalate early when ventilation or airway protection is inadequate.
- Minimise delays to ventilation or interruptions to chest compressions during CPR; any airway intervention should avoid prolonged pauses.
- Maintain spinal precautions when cervical spine injury is suspected-avoid neck extension and use jaw thrust/manual in‑line stabilisation.
- Provide high‑flow oxygen initially and use continuous monitoring (pulse oximetry) and waveform capnography when available to confirm ventilation.
Airway opening manoeuvres
Head‑tilt-chin‑lift
- Indication: unconscious patient without suspected cervical spine injury.
- Technique: with the patient supine, place one hand on the forehead and the other under the bony part of the chin; tilt the head back and lift the chin to align airway axes and lift the tongue off the posterior...