AS11.3-4 | Basic Airway Opening and Airway Adjunct Insertion — Summary & Reflection

KEY TAKEAWAYS

Upper airway obstruction in the unconscious patient is most commonly caused by the tongue falling posteriorly against the pharyngeal wall. The first-line response is the head-tilt chin-lift manoeuvre (or jaw thrust if cervical spine injury is suspected), which displaces the mandible anteriorly and lifts the tongue and hyoid away from the posterior pharynx. If manual manoeuvres alone are insufficient, airway adjuncts are inserted: the oropharyngeal airway (Guedel), sized from corner of mouth to angle of jaw, is inserted inverted and rotated 180° and is used only in patients with absent gag reflex; the nasopharyngeal airway, sized from tip of nose to tragus, is inserted perpendicular to the face along the nasal floor and can be used in semi-conscious patients with preserved gag reflex. Contraindications to NPA include suspected basal skull fracture and coagulopathy. Effectiveness is confirmed by the look-listen-feel triad plus SpO₂ and capnography if available. If basic manoeuvres fail to maintain SpO₂ ≥90%, escalate to bag-valve-mask ventilation and definitive airway management.

REFLECT

After your next clinical posting in anaesthesia or emergency medicine, reflect on every patient you observe whose airway required active management. For each: Was the first intervention a manual manoeuvre or an adjunct? Which adjunct was chosen, and what did the clinician assess before choosing it? Was the sizing verified anatomically or estimated visually? What did the monitoring look like in the 2 minutes after adjunct placement? Compare what you observed with the framework in this module. Where there are differences, ask your supervising clinician the reasoning — in most cases there will be a patient-specific factor that modified the standard approach. Building this reflective habit during your supervised exposure transforms technical knowledge into adaptive clinical judgement.