Chin lift and jaw thrust
To perform a chin lift,
place two fingers under the mandible and gently lift upward
to bring the chin anterior. During this manoeuvre, be careful
hyperextend the neck. Care should be given to neck stabilization,
The jaw thrust is performed
by manually elevating the angles of the mandible to obtain the
Remember these are not definitive procedures and obstruction
may occur at any time.
Insert the oral airway into the mouth behind the tongue; it
is usually inserted upside down until the palate is encountered
and is then rotated 180 degrees. Take particular care in children
because of the possibility of soft tissue damage.
Insert a nasopharyngeal airway (well lubricated) via a nostril
and pass it into the posterior oropharynx. It is well tolerated.
Uncontrolled laryngoscopy may produce cervical hyperextension.
It is essential that in line neck immobilization is maintained
by an assistant. Cricoid pressure may be necessary if a full
stomach is suspected. Inflate the cuff and check the correct
placement of the tube by checking for normal bilateral breath
Consider tracheal intubation when there is a need to:
a patent airway and prevent aspiration
oxygen while not being able to use mask and airway
ventilation and prevent hypercarbia.
intubation should be performed in no more than 30 seconds.
If you are unable to intubate, continue ventilation of the
patient via mask.
Remember: patients die from lack of oxygen, not lack of an endotracheal tube
Surgical cricothyroidotomy should be conducted in any patient where intubation
has been attempted twice and failed and/or the patient cannot be ventilated.
the neck, making the patient comfortable.
the groove between the cricoid and thyroid cartilages
just below the “Adam’s apple” (the protruding
the area and infiltrate with local anaesthetic.
through the skin vertically with a 1.5 cm cut and use
blunt dissection to ensure that you can see the membrane
thyroid and cricoid (Figure 1).
a #22 or #23 scalpel blade, stab through the membrane
into the hollow trachea.
the blade 90° (Figure 2), insert a curved artery
forceps alongside the blade, remove the blade and open
the forceps side to side, widening the space between the
thyroid and cricoid cartilages
a thin introducer or a nasogastric tube into the trachea
if very small access (Figure 4) or proceed to 9.
a 4–6 endotracheal tube over the introducer and
pass it into the trachea (Figure
the introducer, if used.
This tube can stay in place for up to 3 days. Do not attempt this procedure
in a child under the age of 10 years; passing several needles through
the membrane will give enough air entry.
This procedure should be performed by an experienced person, with prior knowledge
of the anatomy and medical condition of the patient.
procedure should not be undertaken bleeding and delay can