2 Airway Management Fundamentals

Why airway support matters

Air must be able to pass through the airway to reach the lungs. Reduced alertness can allow the tongue and soft tissues to obstruct the throat. Blood, vomit, mucus, or a foreign object can also block airflow.

Airway support can range from repositioning and simple maneuvers to suction, airway adjuncts, and assisted ventilation by trained providers.

Recognizing when support is needed

Assess responsiveness and breathing. Warning signs of obstruction or inadequate breathing include:

• Noisy or obstructed breathing, such as snoring, gurgling, or high-pitched stridor.

• Weak or ineffective coughing, difficulty speaking, or visible effort to breathe.

• Blue or gray color, confusion, or decreasing alertness.

Apnea, gasping, or severe obstruction is an emergency: activate emergency services and begin the appropriate CPR response. Do not delay action while trying to identify the exact cause.

For a mild choking obstruction, encourage a person who can cough effectively to keep coughing and watch them closely. Inability to speak, a weak or absent cough, color change, altered mental status, or apnea signals severe obstruction and requires immediate emergency action. Follow current first-aid training for choking care.

Positioning the person

Choose a position according to the person's responsiveness, breathing, and possible injury:

• A responsive person with breathing difficulty can choose a comfortable position; sitting upright often helps.

• An unresponsive person who is breathing normally and has no suspected traumatic injury may be placed on their side in a recovery position if they cannot be closely monitored. This helps keep the airway clear and allows fluids to drain. Continue checking breathing.

• An unresponsive person who is not breathing normally should be placed on their back on a firm surface and managed according to the CPR algorithm. Do not leave them in the recovery position.

Opening the airway

For an unresponsive person when neck injury is not suspected, use the head tilt–chin lift: gently tilt the head back and lift the chin to move the tongue away from the back of the throat.

If head or neck injury is suspected, trained rescuers should try a jaw thrust while minimizing neck movement. If this does not open the airway, airway patency and oxygenation take priority; a trained rescuer may need to use a head tilt–chin lift.

Clearing an obstruction

Remove only objects that are clearly visible and readily accessible in the mouth. Never perform a blind finger sweep, because it may push an object deeper.

Trained providers can use suction to remove secretions, blood, or vomit, with appropriate equipment and monitoring. Reassess breathing after each intervention; airway maneuvers and suction may need to be repeated.

Using basic airway adjuncts

Airway adjuncts help keep soft tissue from obstructing the throat. They should be used by people trained to select, insert, and monitor them. They do not replace monitoring or positioning, or ventilation when breathing is inadequate.

• An oropharyngeal airway (OPA) helps maintain airway patency in an unresponsive person without a gag reflex and is often used during bag-mask ventilation. Do not use it in a conscious or gagging person: insertion can trigger gagging, vomiting, or aspiration. Incorrect size or placement can worsen obstruction.

• A nasopharyngeal airway (NPA) may be better tolerated when a person has an intact gag reflex and may help when oral access is difficult. Avoid it when a basilar skull fracture is suspected; significant nasal trauma is also a concern.

An adjunct can make ventilation easier, but it does not protect against aspiration. If ventilation remains ineffective, seek advanced help and continue reassessing airway position, chest movement, and breathing.