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Establishing or maintaining a patent airway is one of the most fundamental lifesaving skills. Despite circumstances, clinicians must be able to secure an airway with limited or unusual equipment. Depending on a single technique or device is potentially dangerous for the patient.1
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Positioning for Safe Airway
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It is much better to prevent aspiration than to treat it. When there is concern about a patient maintaining his airway, especially if there are copious secretions or vomitus, place the patient in the "rescue" or "recovery" position—on his side with his face aimed toward the bed to prevent aspiration. If possible, also raise the foot of the bed so that the patient is in the head-down position.
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Even patients with extensive and penetrating facial injuries may not need endotracheal intubation if they are put into the recovery position.2
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If the individual has a suspected cervical spine injury, use the High Arm IN Endangered Spine (HAINES) position (Fig. 8-1). The differences from the recovery position are that the dependant upper limb is fully abducted and lies under the head where it reduces lateral neck flexion, and both lower limbs are flexed at the hip and the knee resulting in one lying on top of the other, possibly reducing torque on the thoracolumbar spine. A single rescuer can easily put a patient in the HAINES position.3
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Perhaps the easiest method to maintain an open airway is to simply push the chin up. For somnolent and sedated patients, this is often all that is needed to keep the airway patent. If a cervical spine injury is suspected, push the jaw forward from the mandibular angles.
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Head turn is a simple, but rarely used, procedure to open an airway. In patients with significant amounts of redundant tissue in the pharynx and hypopharynx (and no history of possible acute cervical spine injury), simply turn the head to one side to improve airflow.1
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Positioning the Tongue
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If the patient's tongue still blocks the airway after positioning the head, or if the head cannot be repositioned because of a suspected cervical spine injury, grasp the tongue with gauze and pull it forward. This is a temporizing measure only. For better control over longer periods, put a heavy (~2-0) suture or a wire or suture substitute (such as fishing line) vertically through the tip of the tongue in the midline (Fig. 8-2). Placing it anterior and midline avoids significant bleeding. An assistant can hold the suture or it can be passed through the skin of the lower lip and then tied.4 A towel clip ...