BASIC AIRWAY TECHNIQUES IN ACLS

 

Effective airway management is critical in resuscitation and can mean the difference between life and death. In ACLS, basic airway techniques are the first-line interventions to ensure adequate oxygenation and ventilation before advancing to more complex airway management.

🚨 Key Goals of Basic Airway Techniques:
✅ Ensure a patent (open) airway to facilitate breathing.
✅ Prevent airway obstruction due to the tongue or soft tissues.
✅ Support oxygenation and ventilation in unconscious or semi-conscious patients.
✅ Stabilize the airway before progressing to advanced airway management (if needed).

 

1️⃣ HEAD-TILT/CHIN-LIFT MANEUVER (Preferred for Non-Trauma Patients)

🔹 Used when cervical spine injury is NOT suspected.
🔹 Relieves airway obstruction caused by the tongue.

✅ Steps to Perform the Head-Tilt/Chin-Lift:
1️⃣ Place one hand on the patient’s forehead.
2️⃣ Apply firm backward pressure to tilt the head back.
3️⃣ Place the fingertips of your other hand under the bony part of the chin.
4️⃣ Lift the chin forward without pressing on the soft tissues under the jaw.

🚨 Common Pitfalls:
❌ Avoid pressing on the soft tissue of the neck—this can further obstruct the airway.
❌ Do NOT use this technique if spinal trauma is suspected—it can worsen spinal cord injury.


2️⃣ JAW-THRUST MANEUVER (For Suspected Cervical Spine Injury)

🔹 Used when spinal trauma is suspected (e.g., motor vehicle accidents, falls).
🔹 Opens the airway without tilting the head back, reducing the risk of spinal injury.

✅ Steps to Perform the Jaw-Thrust Maneuver:
1️⃣ Place your fingers behind the angles of the jaw (mandible).
2️⃣ Thrust the jaw forward while keeping the head in a neutral position.
3️⃣ Ensure the tongue is lifted away from the airway.
4️⃣ If needed, use a bag-mask device (BVM) to assist ventilation.

🚨 Common Pitfalls:
❌ Incorrect hand placement can make the maneuver ineffective.
❌ This technique requires more force than the head-tilt/chin-lift, so rescuers may fatigue quickly.


3️⃣ OROPHARYNGEAL AIRWAY (OPA) INSERTION

🔹 The OPA is used in unconscious patients who do NOT have a gag reflex.
🔹 Prevents the tongue from falling back and blocking the airway.

✅ Indications for OPA Use:

  • Unconscious patients with no gag reflex.
  • Patients requiring bag-mask ventilation (BVM) support.

✅ Steps to Insert an OPA:
1️⃣ Select the correct size:

  • Measure from the corner of the mouth to the earlobe or angle of the jaw.
    2️⃣ Open the patient’s mouth using the crossed-finger technique.
    3️⃣ Insert the OPA upside down (curved side facing the roof of the mouth).
    4️⃣ Once resistance is met, rotate 180° and advance into the oropharynx.

🚨 Common Pitfalls:
❌ OPA too large: Can cause airway trauma.
❌ OPA too small: Will not prevent airway obstruction.
❌ Inserted without rotation: The tongue may be pushed further into the airway.


4️⃣ NASOPHARYNGEAL AIRWAY (NPA) INSERTION

🔹 Used when an OPA is contraindicated (e.g., gag reflex is present).
🔹 Can be used in semi-conscious or conscious patients.
🔹 Useful for patients requiring frequent suctioning.

✅ Indications for NPA Use:

  • Semi-conscious patients with an intact gag reflex.
  • Patients unable to tolerate an OPA.
  • Patients requiring frequent airway suctioning (e.g., secretions, blood).

✅ Steps to Insert an NPA:
1️⃣ Select the correct size:

  • Measure from the tip of the nose to the earlobe or jaw angle.
    2️⃣ Lubricate the NPA with water-soluble lubricant.
    3️⃣ Insert the NPA into the nostril (preferably the right nostril, unless resistance is met).
    4️⃣ Advance gently following the natural curve of the nasal passage.
    5️⃣ Ensure the flange rests against the nostril (do not force insertion).

🚨 Common Pitfalls:
❌ Avoid using an NPA if the patient has a suspected skull fracture or facial trauma (risk of inserting into the brain).
❌ Using an NPA that is too large can cause trauma and bleeding.
❌ Forcing the NPA through resistance can cause nasal injury.


5️⃣ COMPARISON OF OPA VS. NPA


FeatureOropharyngeal Airway (OPA)Nasopharyngeal Airway (NPA)
IndicationUnconscious, no gag reflexConscious or semi-conscious, gag reflex present
Insertion RouteMouthNose
Airway Obstruction ReliefPrevents tongue obstructionBypasses soft tissue obstruction
ContraindicationsGag reflex, oral traumaSkull fracture, nasal trauma
Preferred inUnresponsive patients needing BVMPatients needing suctioning or prolonged airway support

🚨 Always assess airway patency after inserting an OPA or NPA—remove if airway obstruction worsens!

 

6️⃣ WHEN TO ESCALATE TO ADVANCED AIRWAY MANAGEMENT

🔹 Basic airway techniques should be used first, but some patients may require advanced airway techniques such as:
✅ Endotracheal Intubation (ETT) – If prolonged airway control is needed.
✅ Supraglottic Airways (LMA, i-gel) – If intubation is not feasible.
✅ Cricothyrotomy – As a last resort in complete airway obstruction.

🚨 If basic airway techniques fail to maintain oxygenation, escalate to advanced airway interventions.

 

7️⃣ COMMON PITFALLS IN BASIC AIRWAY MANAGEMENT


ErrorImpactCorrection
Head-Tilt/Chin-Lift in Suspected Spine InjuryPossible spinal cord damageUse Jaw-Thrust Maneuver instead
Leaning on the Jaw During Jaw-Thrust ManeuverFurther airway obstructionEnsure proper hand placement
Improperly Sized OPA/NPAIneffective airway management, traumaMeasure correctly before insertion
Forcing an NPA in a Skull Fracture PatientRisk of inserting into brain tissueAvoid NPAs in suspected skull fractures
Failure to Suction the AirwaySecretions obstruct ventilationSuction as needed

🚨 Airway management is dynamic—continuously reassess effectiveness and adjust as needed!

 

8️⃣ FINAL TAKEAWAYS: MASTERING BASIC AIRWAY MANAGEMENT IN ACLS

✅ Use the Head-Tilt/Chin-Lift maneuver unless cervical spine injury is suspected.
✅ Use the Jaw-Thrust maneuver for patients with suspected spinal trauma.
✅ Insert an OPA in unconscious patients with no gag reflex.
✅ Use an NPA in semi-conscious patients or those with a gag reflex.
✅ Minimize airway trauma by selecting the correct OPA/NPA size and inserting gently.
✅ Escalate to advanced airway techniques if basic maneuvers are insufficient.

🚑 Takeaway: Basic airway techniques are simple but lifesaving—mastering them ensures effective oxygenation and ventilation in critical situations.