Today we’re going to talk about airway management. In particular we’re going to talk about the jaw thrust when applying it to a patient who has suspected C-spine injury due to trauma. Now one of the things that you will not only read about time and time again but have to be able to demonstrate safe practice in is managing the patient with both a blocked airway or who is just unconscious and who may potentially have a blocked airway.

Now as you know the primary survey’s a systematic approach that we use to manage a patient who is unconscious or conscious or otherwise. And after the danger response then next thing on the primary survey is the airway.

As you can see here on this image, we have a picture of an upper airway, the lower airways starts here at the entrance to the trachea. So whenever we’re talking about upper and lower you now know that the upper is the nasal and the oral pharynx. And the beginning of the trachea is lower. So in other words, the part of the airway where you can no longer see is the lower airways.

What you can also see from this image is the tongue and how huge it is. It’s a massive tongue that can potentially stop the air from traveling through the oral pharynx and into the trachea and into the lungs.

Now when you’re dealing with a patient who’s got suspected C-spine injury we do not do a head tilt chin lift manoeuvre to open this patients airway. Instead, what we use is the jaw thrust. Now what you can see here on the right is the chin lift or the head tilt chin lift. What we want to look at today is this notion of the jaw thrust.

Now the jaw thrust is a manoeuvre that you will use in a patient who you are suspecting a C-spine injury. Now on the C-spin injured patient you’re doing everything possible to try and keep the head still. Now when you’re applying the jaw thrust notice how the fingers are behind the jaw, here is the angle of the jaw here and the fingers are here just behind it. And what they’re doing is they’re displacing the jaw upwards to be able to open the airway. Now when you add into that a head tilt chin lift which is what they’re doing here in this image here, that’s actually called the triple manoeuvre.

Now you probably can’t see it that well from this image but … so step one is to displace the jaw anteriorly, which is what’s going on here. Step two is to move the mouth open, which is what you can’t see. Now you can see that the thumbs are in the right place but you can’t see a great amount of open airway. Which is fine because the opening part only aids slightly to the actual displacement of the tongue. Now the third part is to do the head tilt chin lift part. So step one is to displace the jaw using your fingers, step two is to use the thumbs as you can see on the image here to open the mouth, and step three is to do the head tilt chin lift as an absolute last resort if you still can’t maintain the airway.

Now don’t forget guys you will get a chance to practice this at the face to face workshops. But that’s the triple manoeuvre including the jaw thrust.