HEAD-TILT/CHIN-LIFT MANEUVER
The head-tilt/chin-lift maneuver is a simple yet essential airway-opening technique used in unresponsive patients who do not have a suspected cervical spine injury. It is one of the most fundamental airway management skills and is frequently the first intervention performed in airway management.
Why It’s Important:
Prevents the tongue from obstructing the airway. Quick and effective for opening the airway in unconscious patients. Essential for providing adequate ventilation with a bag-valve mask (BVM).
HOW THE HEAD-TILT/CHIN-LIFT WORKS
In unconscious patients, the tongue relaxes and can fall backward, blocking the airway.
The head-tilt/chin-lift maneuver lifts the tongue off the posterior pharynx, creating a clear airway.
This technique should ONLY be used in patients without suspected spinal injury!
INDICATIONS FOR HEAD-TILT/CHIN-LIFT
Unresponsive patients who need airway support. No suspected cervical spine injury (e.g., not a trauma patient). Patients requiring assisted ventilation (e.g., bag-valve-mask ventilation).
This maneuver is often used as the first step in CPR and basic airway management.
CONTRAINDICATIONS
Suspected cervical spine injury
- If the patient has suffered trauma (e.g., motor vehicle accident, fall, blunt injury), avoid moving the head as this could worsen a spinal cord injury.
- Instead, use the jaw-thrust maneuver, which keeps the cervical spine in a neutral position.
TECHNIQUE: HOW TO PERFORM THE HEAD-TILT/CHIN-LIFT
Step-by-Step Instructions:
Positioning the Patient:
- Place the patient supine (on their back) on a firm, flat surface.
Head Tilt:
- Place the palm of one hand on the patient’s forehead.
- Apply firm, gentle pressure backward to tilt the head into slight extension.
Chin Lift:
- Place the fingertips of your other hand under the bony part of the patient’s chin.
- Gently lift the chin forward, bringing the jaw with it.
Ensure a Clear Airway:
- Keep the mouth slightly open.
- Do NOT press on the soft tissues under the chin, as this can further block the airway.
Maintain the Position:
- Continue holding the maneuver while assessing breathing or delivering ventilations.
Key Tip: If the patient remains unresponsive and you need to continue airway support, an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) may be necessary to maintain patency.
COMMON ERRORS & HOW TO AVOID THEM
| Error | Impact | Correction |
|---|---|---|
| Pressing on the soft tissues of the neck | Can further obstruct the airway | Place fingers ONLY on the bony part of the chin |
| Not tilting the head back far enough | Airway remains partially blocked | Ensure full head extension |
| Not lifting the chin sufficiently | Tongue may still obstruct the airway | Lift the chin enough to open the mouth |
Performing the maneuver incorrectly can prevent effective ventilation—practice is essential!
WHY THE HEAD-TILT/CHIN-LIFT IS A CRITICAL SKILL
It is the first step in airway management for most unresponsive patients. It can quickly restore airway patency in patients with airway obstruction due to tongue collapse. It is essential for providing effective ventilation during BLS and ACLS interventions. It is one of the first skills taught in BLS because of its simplicity and effectiveness.
Takeaway: Mastering the head-tilt/chin-lift maneuver ensures that airway obstruction is quickly relieved, maximizing the chances of successful ventilation and resuscitation.