VOL: 102, ISSUE: 26, PAGE NO: 26 Phil Jevon, PGCE, BSc, RN, is resuscitation officer/clinical skills lead, Manor Hospital, Walsall Patients who need resuscitation often have airway

obstruction, usually secondary to loss of consciousness but sometimes as the primary cause of the cardiorespiratory arrest (Nolan et al, 2005). Airway obstruction can be subtle and is often

undetected by healthcare professionals (Nolan et al, 2005). Nurses must be competent at basic airway management. Whatever the cause of airway obstruction, prompt recognition and effective

treatment is essential, particularly during resuscitation, as an open and clear airway is essential to help ensure adequate ventilation. This article describes basic airway management

(Nolan et al, 2005). Complete airway obstruction in a patient who is not breathing is usually recognised by a lack of chest rise during attempted ventilations. The presence of a gurgling

sound during ventilations indicates the presence of fluid/vomit in the patient’s airway or in an airway device such as a tracheal tube. The use of a clear resuscitation face mask facilitates

prompt recognition of vomit and secretions in the mouth. OPENING/CLEARING AIRWAYS Head tilt, chin lift and jaw thrust are manoeuvres that can improve patency of an airway obstructed by the

tongue or other upper airway structure, such as the soft palate and epiglottis (Nolan et al, 2005). During resuscitation, the simple head tilt/chin lift manoeuvre can achieve airway patency

in 91% of cases (Guildner, 1976). A pillow under the patient’s head and shoulders can help to maintain this position. As regurgitation of gastric contents and vomiting commonly occur during

resuscitation, suction is regularly required and proficiency in applying it is essential. PROCEDURE - Don disposable gloves (Fig 1) if possible. - Turn patient onto her or his back. - Open

the airway: tilt the head and lift the chin (Fig 2). Place one hand on the patient’s forehead and gently tilt the head back; at the same time, place the fingertips of the other hand under

the point of the patient’s chin and lift the chin upwards. - Check the patient’s mouth. - If vomit/fluid is present, turn the patient’s head on the side and apply suction using a wide-bore

rigid (Yankeur) catheter (Fig 3). This device can provide rapid suction of large volumes of vomit or secretions from the mouth and the pharynx. Although the patient should ideally be placed

in the lateral position in order to help protect the airway from aspiration, this is not practical during resuscitation. Suction is often applied with just the patient’s head turned to the

side, while chest compressions are continued. - Use a flexible suction catheter if applying suction to an airway adjunct, for example the oropharyngeal airway (Fig 4). - If there is a

foreign body in the mouth, remove it using forceps or a finger sweep (Fig 5). - Remove displaced or broken dentures (Nolan et al, 2005). Leave well-fitting dentures in place because they

will help to maintain the normal shape of the face, facilitating an adequate seal with a mask device (Jevon, 2002). - The jaw thrust (Fig 6) is an alternative method to open the airway. The

mandible (together with the tongue) is displaced anteriorly using the index fingers positioned just proximal to the angles of the jaw. Pressure by the thumbs on the chin at the same time can

help open the mouth. - If a cervical spine injury is suspected, for example following a blow to the head or neck, perform jaw thrust or chin lift with simultaneous manual in-line head and

neck immobilistion by an assistant (Lennarson et al, 2001). Excessive head tilt could aggravate the injury and cause damage to the cervical spine (Donaldson et al, 1997). However, if

life-threatening airway obstruction persists, despite the application of effective jaw thrust or chin lift, head tilt should be increased gradually until airway patency is achieved.

Establishing a clear airway takes priority over concerns about potential injury to the cervical spine (Nolan et al, 2005). - Reassess (look, listen and feel) to ensure an open and clear

airway has been achieved and continually monitor its patency. CONCLUSION Effective airway management is an important part of resuscitation. It is vital to be able to promptly recognise

airway obstruction and treat it effectively. PROFESSIONAL RESPONSIBILITIES All nurses who carry out clinical procedures must have received approved training, undertaken supervised practice

and demonstrated competence in the clinical area. The onus is also on the individual to ensure that knowledge and skills are maintained from both a theoretical and a practical perspective.

Nurses should also undertake this role in accordance with an organisation’s protocols, policies and guidelines.