Airway Management
Airway Obstruction
In order for oxygen from the air to flow to and from the lungs, the upper airway must be
unobstructed. Upper airway obstructions often occur because:
 The tongue falls back into his throat while he is unconscious.
 Foreign bodies become lodged in the throat usually occur while eating.
 Choking on food (usually meat) is associated with attempting to swallow large pieces of
poorly chewed food.
 The contents of the stomach are regurgitated and may block the airway.
 Blood clots may form as a result of head and facial injuries.
Upper airway obstruction may cause either partial or complete
 Partial airway obstruction.
The victim may still have an air exchange. A good air exchange means that the victim
can cough forcefully, though he may be wheezing between coughs. A poor air exchange
may be indicated by weak coughing with a high pitched noise between coughs.
 Complete airway obstruction.
A complete obstruction (no air exchange) is indicated if the victim cannot speak, breathe,
or cough at all. He may be clutching his neck and moving erratically. In an unconscious
victim, a complete obstruction is also indicated if after opening his airway you cannot
ventilate him.
Choking
Choking occurs when a foreign object becomes lodged in the throat or trachea, blocking
the flow of air mostly caused by a piece of food or swallowing small objects. Once an
obstructed airway occurs, the brain will develop an oxygen deficiency resulting in
unconsciousness. Death will follow rapidly if breathing is not promptly restored.
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Dr. Maysoon S. Abdalrahim
The universal sign for choking is hands clutched to the throat. If the person doesn't give
the signal, look for these indications:

Inability to talk

Difficulty breathing or noisy breathing

Inability to cough forcefully

Skin, lips and nails turning blue

Loss of consciousness
Airway obstruction first aid
 If the victim can speak, encourage him to attempt to cough; he still has a good air
exchange.
 If he is able to speak or cough effectively, DO NOT interferes with his attempts to expel
the obstruction.
 If there is poor air exchange or no breathing, CALL 911 and immediately deliver
manual thrusts (either an abdominal or chest thrust according to the AHA).
 The manual thrust with the hands centered between the waist and the rib cage is called
an abdominal thrust (or Heimlich maneuver).
 The chest thrust (the hands are centered in the middle of the breastbone) is used only for
an individual in the advanced stages of pregnancy, in the markedly obese victims, or if
there is a significant abdominal wound.
The Red Cross recommends a "five-and-five" approach to delivering first aid:
1. Deliver 5 back blows between the person's shoulder blades with the heel of your hand.
2. Perform 5 abdominal thrusts (the Heimlich maneuver).
3. Alternate between 5 back blows and 5 abdominal thrusts until the blockage is dislodged.
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Dr. Maysoon S. Abdalrahim
 If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 for
help. If another person is available, have that person call for help while you perform first aid.
To perform abdominal thrusts (Heimlich maneuver) on someone else:
 Stand behind the person. Wrap your arms around the waist. Tip the person forward
slightly.
 Make a fist with one hand. Position the thumb side of your fist against the casualty’s
abdomen below the tip of the ribcage.
 Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward
thrust — as if trying to lift the person up.
 Perform a total of five abdominal thrusts, if needed. If the blockage still isn't dislodged,
repeat the "five-and-five" cycle.
 Continue performing abdominal thrusts until the obstruction is expelled or the victim
becomes unresponsive.
To perform abdominal thrusts (Heimlich maneuver) on your-self:
If you're alone and choking, you'll be unable to effectively deliver back blows to yourself.
However, you can still perform abdominal thrusts to dislodge the item.
 Place a fist slightly above your navel.
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Dr. Maysoon S. Abdalrahim
 Grasp your fist with the other hand and bend over a hard surface — a countertop or chair
will do.
 Thrust your fist inward and upward.
Apply chest thrusts
This technique is useful when the clearing the airway of a pregnant woman or obese person, or
when the victim abdominal wound:
 Apply chest thrusts with casualty sitting or standing.
 Stand behind the victim and wrap your arms around his/ her chest with your arms under
his axilla.
 Make a fist with one hand and place the thumb side of the fist in the middle of the
sternum.
 Proceed as with the Heimlich maneuver, pressing hard into the chest, with a quick
thrust.
 Repeat until the food or other blockage is dislodged or the person becomes unconscious.
Clearing the airway of an unconscious person:
 Lower the person on his or her back onto the floor.
 If there's a visible blockage at the back of the throat or high in the throat, reach a finger
into the mouth and sweep out the cause of the blockage. Be careful not to push the food
or object deeper into the airway, which can happen easily in young children.
 Begin cardiac compressions (as in CPR) if the object remains lodged and the person
doesn't respond after you take the above measures. The chest compressions used in CPR
may dislodge the object. Remember to recheck the mouth periodically.
Clearing the airway of a choking infant younger than age 1:
 Assume a seated position
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Dr. Maysoon S. Abdalrahim
 Hold the infant facedown on your forearm, which is resting on your thigh.
 Thump the infant gently but firmly five times on the middle of the back using the heel of
your hand. The combination of gravity and the back blows should release the blocking
object.
 If back blows does not work: Hold the infant face up on your forearm with the head
lower than the trunk if the above doesn't work. Using two fingers placed at the center of
the infant's sternum, give five quick chest compressions.
 Repeat the back blows and chest thrusts if breathing doesn't resume.
 If breathing doesn't resume: Call 911 and begin infant cardiac compressions.
If the child is older than age 1, follow directions of first aid for adult victims using
abdominal thrusts only.
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Dr. Maysoon S. Abdalrahim