Airway assessment and basic airway management: Viva

Branch 1: Recognising the obstruction and opening the airway

The candidate should recognise at once that the snoring, minimal chest movement, and low saturation mean the unconscious child's airway is obstructed by the tongue and soft tissues, and that this is the proximate threat to life. The first action is to open the airway with a head tilt and chin lift, because there is no suggestion of trauma, and to suction any secretions, then reassess for chest movement and air at the mouth. ^[1]

The examiner may probe why the child obstructs so readily. The candidate should explain the paediatric airway differences that make tongue obstruction common and dangerous: a large occiput that flexes the neck supine, a tongue that is large relative to the oral cavity and falls back when tone is lost, and the physics by which resistance rises with the inverse of the radius to the fourth power, so a small child obstructs rapidly. The key teaching point is that the narrowest point of the child's airway is the cricoid cartilage, not the vocal cords. ^[2]