Basic Airway Management
Maintenance of a patent airway is essential to prevent a patient’s condition
deteriorating and leading to cardiac arrest. This can be achieved by the use of
simple airway opening manoeuvres and/or the use of airway adjuncts.
Airway opening manoeuvres
These are designed to lift the tongue away from the posterior pharyngeal wall
Head tilt, chin lift involves placing one hand on the forehead and gently tilting the
head back whilst placing the fingertips of the other hand under the point of the
patients’ chin and lifting upwards to stretch the anterior neck structures.
N.B. This is contra- indicated in patients with suspected c- spine injury.
Jaw thrust involves placing the index and other fingers behind the angle of the
mandible and applying a steady upwards and forward pressure to lift the mandible.
The thumbs should be used to open the mouth by downward displacement of the
chin.
This manoeuvre is used for patients with suspected cervical spine injury.
If any of the above manoeuvres are implemented the patient must always be
re-assessed to ensure the intervention has been effective.
Suction
Suction involves the removal of blood/vomit or other liquids to clear the airway. This
can be achieved by the use of a suction device and suction catheters. Suctioning
should be performed at the inner sides of the mouth and used to remove only what
Please ensure you refer to local policy before undertaking any procedure
can be seen. Gagging can be stimulated if the catheter is passed across the soft
palate and care should be taken to prevent damage to soft tissue when using hard
plastic yankuer suction catheters.
Immediately following the use of suction the patient must be re-assessed to ensure
the intervention has been effective.
Nasopharyngeal tubes
This is a soft plastic tube with a bevel at one end (to aid insertion) and a flange at the
other (to prevent displacement into the nose). It is usually tolerated in a conscious
patient and can be used to:
Remove secretions at the back of the pharynx

Ensure adequate oxygenation in patients with clenched jaws (Trismus) /
maxillofacial injuries if deemed appropriate.
Size 6 and 7mm diameter tubes are suitable for adults, though measuring from the
tragus on the ear to the external nares will estimate the appropriate length of the
tube.
It is inserted by introducing the lubricated tube, bevel end first, vertically along the
floor of the nose. The right nostril is the first choice as it is usually larger. Insertion
should stop immediately any obstruction / resistance is encountered.
N.B. Nasopharyngeal tubes are contraindicated in patients with suspected base of
skull fractures, due to the theoretical possibility / risk of the tube of entering the brain
through the fracture site.
If a nasopharyngeal tube is used the patient must s be re-assessed to ensure the
intervention has been effective.
Please ensure you refer to local policy before undertaking any procedure
Oropharyngeal airways
The oropharyngeal airway (commonly known as a Guedel airway) is a curved plastic
tube with a reinforced bite plate at one end. It comes in several sizes and is
designed to fit from the incisors, over the tongue to the pharyngeal wall. It is used for
unconscious patients to help maintain the airway.
The airway size is estimated by measuring the tube against the vertical distance
from the angle of the mandible to the level of the incisors.
Placement is achieved by inserting the airway “upside down” into a clear airway, as
far as the junction of the hard and soft palate. It is then rotated through 180 degrees
and advanced until it lies against the pharynx.
N.B. It must never be used on the conscious patient.
If an oropharyngeal airway is used the patient must be re-assessed to ensure the
intervention has been effective.
The look, listen and feel approach
The look, listen and feel approach is a method of assessing a patients breathing and
airway patency. It is essential to check that interventions have been effective and
this approach is a useful tool.
Look for:
foreign bodies (e.g. dentures, food), use of accessory muscles in
particular see-saw pattern of respiration
Listen for: gurgling sounds (fluid), strider, wheezes, snoring sounds
Feel for: breaths from nose/mouth
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T-DOCS: Airway Management
Name……………………………………
WMS No………………………..
A patient with a compromised airway has been admitted to A&E, please show how
you will manage his airway.
Washes Hands
Hand wash using the Ayliffe technique.
Uses appropriate PPE
Puts on gloves and apron
Understands indications &
anatomy
Explains why it is important to maintain a patent
airway.
Explains the anatomy of the airway.
Consent issues
Explains procedures correctly for a semiconscious patient
Explanation to patient, often
including complications
Communication skills
I Explains the ethical issues concerning consent
in an unconscious patient.
Communicates effectively and politely with
colleagues
Appropriate preparation
Ensures all airway equipment is ready for use
Demonstrates what checks need to be
undertaken prior to using airway equipment.
Technical ability especially
with any special equipment
and sharps
Initial airway assessment
Demonstrates how to use the look, listen and feel
technique to assess the airway.
Airway opening manoeuvres
Explains when chin lift head tilt should be used
Demonstrates chin lift and head tilt correctly
Explains when jaw thrust should be used
Demonstrates jaw thrust correctly
Assesses airway and ventilation following the
intervention.
Suction
Explains when suctioning is indicated
Demonstrates the correct method for suctioning
Assesses airway and ventilation following the
intervention.
Please ensure you refer to local policy before undertaking any procedure
Oropharyngeal airway
Discusses the indications and contraindications
Demonstrates the correct sizing technique
Demonstrates the correct insertion technique
Assesses airway and ventilation following the
intervention.
Nasopharyngeal airway
Discusses the indications and contraindications
Demonstrates the correct sizing technique
Demonstrates the correct insertion technique
Assesses airway and ventilation following the
intervention.
Seeks help as appropriate
Calls for help when required.
Discusses when expert help should be sought.
Post procedure management
Escalates interventions as appropriate
Correctly disposes of used equipment safely.
Professionalism
Demonstrates appropriate professional behaviour
Overall ability to perform
procedure
Assess globally, would you be happy for this
student to be supervised using appropriate
interventions to manage the airway in a real
patient?
Overall Grade
BE
B
S
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AE
T- DOCS:
For Medical Students
Name of Student
Clinical Skill ………………………………..
Areas of good practice
1.
2.
3.
Areas for improvement
1.
2.
3.
Global assessment:
Below Expectation
Borderline
Satisfactory
Skills labs
Supervised
Skills labs
Patient Safe
Unsupervised
Supervised
Above Expectation
Teaching Potential
Assessor signature:
Job Title
Name
Date
Signature
Please print:
How suitable do you think this assessment is for undergraduate medical students?
Not Suitable
Highly Suitable
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Any other Comments: Free text please use!
Please ensure you refer to local policy before undertaking any procedure