CWI - Airway Manoeuvres and Positioning

Question 1

What are the indications of Airway manoeuvres and positioning?

Answer 1

Question 2

What are the contraindications of Airway manoeuvres and positioning?

Answer 2

Question 3

What are the precautions of Airway manoeuvres and positioning?

Answer 3

Question 4

What equipment is required for CWI - Airway manoeuvres and positioning?

Answer 4

• towel/sheet/blanket

Question 5

What causes an unconscious patient to “lose” their airway

Answer 5

• Airway patency is maintained by pharyngeal muscles or muscles in the upper airway
• When a patient becomes unconscious, these muscles relax which can lead to obstruction of the airway by soft tissue (soft palate, tongue and/or epiglottis) galling back against the posterior wall of the oropharynx

Question 6

What is the aim of maintaining an airway

Answer 6

• To achieve the same basic anatomical goal → to lift soft tissue away from the posterior wall of the oropharynx, relieving the obstruction of the airway

Question 7

What are the 5 different airway positions

Answer 7

Question 8

When would you place someone in the neutral position?

Answer 8

Question 9

When would you place someone in the sniffing position?

Answer 9

Question 10

When would you place someone in the lateral position?

Answer 10

Question 11

When would you place someone in the head tilt/chin lift position?

Answer 11

Question 12

When would you place someone in the triple airway manoeuvre position?

Answer 12

Question 13

Explain the ‘neutral position’

Answer 13

Question 14

Explain the ‘sniffing position’

Answer 14

Question 15

Explain the ‘lateral position’

Answer 15

1. Support head/neutral spinal alignment (if potential for spinal injury)
   For patients who are not at risk of spinal injury, this step may be omitted if resources or urgency require (e.g. assistant not available, vomiting patient)
2. Place the patients right arm perpendicular to body
3. Place left arm across chest
4. Flex left hip and knee
5. Roll patient onto their right side
6. Ensure the left hip and knee remain flexed
   Prevents patient from rolling too far to their right
7. Ensure the head is extended
   Prevents anatomical obstruction of the airway
   Towels of pillows may be required to maintain the position
   Closely monitor this position as it may be altered by movement

Question 16

Explain the ‘head tilt and chin lift’

Answer 16

1. Tilt the head backways with one hand
   AND
2. Lift the chin anteriorly with the other hand

• The goal is to place the neck in an extended position with the tongue lifted off the back of the throat
• A modified technique using both hands to provide additional neck extension prior to chin lift may be required to assist in maintaining the position

Question 17

Explain the ‘Triple airway maneuver’

Answer 17

Each step can be performed concurrently or individually if troubleshooting anatomical obstruction

1. Head tilt
   Place hands on either side of the patients head and gently tilt it back
2. Jaw Thrust
   With fingers placed behind the mandibular angle and thumbs on the chin, lift the jaw upwards. Maintain this position
3. Open mouth
   Use both thumbs to open the mouth and visualise the oropharynx (look for obstruction)

Avoid pressure on the sub-mandibular soft tissues as this may constribute to airway obstruction

Potentional spinal injury:
* Avoid head tilt → attempt to maintain aiway with jaw thrust and mouth opening only
* Consider OPA or NPA
* Use head tilt as last resort

*** good video on CWI