Management
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If the C-spine is not injured, place the head in the sniffing position with the chin lift maneuver to open the airway.
In the sniffing position, the head is slightly extended and the neck is flexed on the shoulders. This aligns the axis of the airway with the mouth and pharynx, facilitating direct visualization of the cords during intubation. It is particularly important in young children and infants, in whom the larynx is considerably more anterior. Placing a pad underneath the occiput will lift the head and align the ear with the sternal notch, facilitating optimal positioning for intubation.
This position cannot be used when there is cervical spine injury.
For patients with potential C-spine injuries, a jaw-thrust maneuver should be used. Clear the airway of obstructions, using a rigid suction catheter to remove any blood, vomitus, or secretions from the oropharynx. Remove any large obstructing foreign bodies from the oropharynx manually or with Magill forceps (see Chapter 9). Do not perform a blind finger sweep of the oropharynx if foreign body suspected.