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Fig. 6.15 Left image: Upper airway obstruction caused by the tongue falling backward in the supine unconscious patient. Right image: Insertion of an oropharyngeal airway restores airway patency.

Upper Airway Obstruction:

The most common cause of an upper airway obstruction in an unconscious supine patient is the tongue falling back into the hypopharynx (Fig. 6.15). In the unconscious state, there is a decrease in the tone of muscles attaching the tongue to the mandible, hyoid bone, and epiglottis. The respiratory efforts of the unconscious patient tend to pull the tongue backward causing further airway obstruction, and ultimately, the epiglottis tends to fall downward, also increasing upper airway obstruction. Apart from intubation, simple maneuvers to overcome upper airway obstruction in the unconscious supine patient include:

1 Clear the airway of any foreign material

2 Use a chin lift maneuver

3 Use a jaw thrust maneuver

4 Insert an oral and/or nasal airway

5 Position the patient on the side in the semi-prone recovery position.