Airway assessment and basic airway management: Case

This unconscious toddler presents with airway obstruction from the tongue and soft tissues, signalled by snoring, minimal chest movement, pallor, and a low oxygen saturation. The first priority is to open and ventilate the airway within the first minute, because most paediatric arrests are respiratory, and an airway opened early can prevent progression to cardiac arrest altogether. ^[1]

Clinical findings

The key findings are the snoring, which localises the obstruction to the tongue falling back against the posterior pharynx as pharyngeal tone is lost, the minimal chest movement that confirms inadequate ventilation, and the pallor and low saturation. The large occiput has flexed the neck in the supine position, worsening the obstruction, and the copious secretions further threaten the airway. ^[2]

The candidate should assess the airway with look, listen, and feel over about five seconds, and recognise that the child is unconscious with no gag reflex, which determines the choice of adjunct. They should also note that the absence of trauma means a head tilt and chin lift is the appropriate opening manoeuvre, and they should be alert to the pre-terminal signs of softening noise and falling effort should the child tire further. ^[1]