Maintenance of an airway

Maintenance of an airway - Airways must remain free from obstruction to enable effective respiratory function and thus sustain life. Remember, if the client has stopped breathing instigate artificial respirations immediately (see the section on ‘Artificial respiration’). The procedures and rationales are given below.

Procedure	Rationale
Listen for breath sounds	Noisy laboured breathing or a stridor would indicate an obstruction
Observe chest and abdominal movement	Reverse movement of these, i.e. chest sucked in and abdomen protruding indicates an obstruction
Observe colour of skin/mucous membranes	Evidence of a blue tinge (cyanosis) is suggestive of an obstruction
ADULT (over 16 years) If you suspect an obstruction check in the client’s mouth for any obvious obstruction, e.g. vomit, foreign body, etc. and remove same by sweeping the mouth with a finger. Great care should be taken not to push any foreign body further into the air passage. See also Chapter 5	Removal of an obvious obstruction will open the airways
CHILD (1–16 years)/INFANT (0–12 months) If the client is a child or infant only remove the obstruction if it is possible to do so without sweeping the mouth with a finger	Sweeping the mouth with a finger may cause serious trauma and/or further obstruct the airway
ADULT If unconscious tilt the head well back and lift the chin	When unconscious the tongue may sag in the throat and block the airway. By tilting the head and lifting the chin the tongue will be lifted clear of the back of the throat. If airway clearance is not obtained try a jaw thrust
CHILD If the child is unconscious gently lift the chin and tilt the head only slightly (i.e. sniffing position, see Figure 1.2b)	If the head of a child or infant is tilted too far back it will act to decrease the area of functional airway rather than maximize it. If airway clearance is not obtained try a jaw thrust
INFANT The desirable degree of tilt in the infant is neutral
ADULT Place client in recovery position (see the section ‘Moving and positioning clients’ in Chapter 2) once normal respiratory function is restored	To maintain patient safety
CHILD/INFANT Assist the child to find a comfortable position once normal respiratory function is restored	A child/infant will often find the best position to maintain their airway and should not be forced into a position which is uncomfortable

(a) Head tilt and chin lift (adult); (b) Head tilt and chin lift (child)

a) Courtesy of Samantha Athorn

b) Reproduced from Mackway-Jones K et al (2001) Advanced Paediatric Life Support: The Practical Approach, 3rd edn. London: BMJ Books, with the kind permission of the Advanced Life Support Group.

(a) Jaw thrust (adult); (b) Jaw thrust (child)

a) Courtesy of Samantha Athorn

b) Reproduced from Mackway-Jones K et al (2001) Advanced Paediatric Life Support: The Practical Approach, 3rd edn. London: BMJ Books, with the kind permission of the Advanced Life Support Group.

Neutral (infant)

Reproduced from Mackway-Jones K et al (2001) Advanced Paediatric Life Support: The Practical Approach, 3rd edn. ondon: BMJ Books, with the kind permission of the Advanced Life Support Group.