2.2 Adult Airway Opening & Rescue Breathing

2.2 Adult Airway Opening & Rescue Breathing

An unresponsive person's tongue and relaxed soft tissues can obstruct airflow. BLS airway care begins with positioning, an appropriate opening maneuver, and breaths that create visible chest rise without excessive pressure or frequency.

Open the airway

When trauma is not suspected, use the head-tilt/chin-lift:

1. Place one hand on the forehead and gently tilt the head back.
2. Place the fingertips of the other hand on the bony underside of the chin.
3. Lift the chin forward and upward.

Do not press deeply into the soft tissue under the chin, because that can worsen obstruction. Do not close the mouth while lifting the jaw.

If cervical spine injury is suspected and a trained rescuer can perform it, begin with a jaw thrust without head extension. Place the fingers behind the angles of the lower jaw and lift the mandible forward. Opening the airway and providing oxygenation remain priorities. If the jaw thrust does not open the airway, use a head-tilt/chin-lift rather than leaving the airway obstructed.

Use an appropriate barrier or mask

A pocket mask with a one-way valve can be used by one rescuer. Position the mask over the bridge of the nose and the cleft of the chin, create a seal, and hold the airway open. A bag-mask device is most effective when two trained rescuers are available: one uses both hands to maintain the airway and mask seal while the other squeezes the bag.

Follow local infection-control practice and use available protective equipment. Do not delay immediately needed compressions while searching indefinitely for a preferred ventilation device.

Deliver effective breaths

Each breath should:

• Be delivered over about 1 second.
• Produce visible chest rise.
• Stop once adequate rise is seen.
• Allow passive exhalation before the next breath.

If the chest does not rise, re-open the airway, improve the mask seal, and try again. If two breaths do not produce rise, consider an airway obstruction and continue the appropriate CPR or FBAO sequence. Do not respond by rapidly forcing a large volume into the airway.

Excessive ventilation means breaths are too frequent, too forceful, or too large. It can inflate the stomach and increase pressure in the chest. The practical safeguard is simple: one breath over 1 second, only to visible chest rise, at the correct interval.

Choose the rate from the pulse finding

Definite pulse, no normal breathing

This is respiratory arrest rather than cardiac arrest. Give 1 breath every 6 seconds—10 breaths per minute. Reassess the pulse and breathing about every 2 minutes. If the pulse is no longer definitely present, begin CPR. If normal breathing returns, maintain the airway and monitor until advanced care takes over.

No definite pulse

Begin CPR with cycles of 30 compressions and 2 breaths when no advanced airway is in place. After 30 compressions, open the airway, give 2 breaths over about 1 second each with visible chest rise, and restart compressions. Keep the entire interruption under 10 seconds.

Advanced airway in cardiac arrest

Once an advanced airway is in place, the compressor gives continuous compressions and the ventilation rescuer gives 1 breath every 6 seconds for an adult. Do not pause compressions for those breaths.

Vomiting or secretions

If vomit or secretions prevent ventilation, turn the patient only as needed to clear the airway, use suction when available and within training, and resume care promptly. A prolonged interruption creates more harm than a short, coordinated airway-clearing action.

Common errors

• Tilting the head while pushing on the soft tissue under the chin.
• Abandoning airway opening after an ineffective jaw thrust despite absent airflow.
• Delivering breaths as fast as possible.
• Squeezing until the entire bag empties rather than watching for chest rise.
• Pausing compressions longer than 10 seconds for two breaths.
• Continuing rescue breaths without periodic reassessment of pulse and breathing.

Exam questions often test the branch between respiratory and cardiac arrest. A definite pulse means rescue breaths at 1 every 6 seconds; no definite pulse means CPR with compressions and breaths.

Skill rehearsal

Practice the airway sequence in short rounds: open the airway, seal the mask, give a 1-second breath to visible rise, and let the chest fall. Have a partner deliberately create a small leak so you can correct head position and seal without increasing force. Then alternate between the respiratory-arrest timer and the 30:2 CPR pattern. This makes the pulse-based decision and the correct breath interval automatic while reinforcing that visible rise—not bag size—is the endpoint.