🚑 Emergency Care intermediate Lesson 4 of 7 4 min read

Airway Management and Breathing Support

How to recognize and open a blocked airway, relieve choking, position an unresponsive breathing patient, and support inadequate breathing with rescue breaths and oxygen.

Reading level

What you'll learn

  • Recognize the signs of an open versus an obstructed airway.
  • Compare the head-tilt/chin-lift and jaw-thrust maneuvers and when each is used.
  • Describe how to relieve a severe airway obstruction in a responsive adult.
  • Explain the purpose of the recovery position and basic rescue breathing.

Overview

Air must move freely in and out of the lungs for the body to survive. When the airway is blocked or breathing fails, brain cells begin to die within minutes. This lesson explains how to recognize an open versus a blocked airway, how to open it safely, how to relieve choking, and the concepts behind rescue breathing and supplemental oxygen.

Important: This is educational content and not a substitute for certified hands-on training such as an American Heart Association or Red Cross course. Airway skills require supervised practice. In a real emergency, call your local emergency number immediately.

Recognizing an Airway Problem

A patent airway is open and unobstructed. In a responsive person, the ability to speak clearly is a good sign the airway is open. In an unresponsive person, the airway is at risk because the tongue can fall back and block it.

Listen for warning sounds:

SoundLikely cause
SnoringTongue partially blocking the airway
GurglingFluid such as vomit or blood
Stridor (high-pitched)Swelling or a narrowed upper airway
Silence with no air movementComplete obstruction

Opening the Airway

Two manual maneuvers open a blocked airway:

  1. Head-tilt/chin-lift — Place one hand on the forehead and lift the chin with the fingers of the other hand, tilting the head back. This lifts the tongue off the back of the throat. Use it when there is no suspected spinal injury.
  2. Jaw-thrust — Without tilting the head, place fingers behind the angles of the jaw and push it forward. Use it when a spinal injury is suspected, such as after a fall or car crash, because it opens the airway with minimal neck movement.

Relieving Choking (Airway Obstruction)

A foreign object such as food can block the airway. Assess severity first:

  • Mild obstruction — the person can still cough forcefully, speak, or breathe. Encourage them to keep coughing and do not interfere.
  • Severe obstruction — the person cannot speak, cough, or breathe and may clutch the throat. Act immediately.

For a responsive choking adult with a severe obstruction:

  1. Confirm they are choking and ask if you can help.
  2. Stand behind them and place a fist just above the navel.
  3. Grasp the fist with your other hand and give quick inward and upward abdominal thrusts.
  4. Repeat thrusts until the object is expelled or the person becomes unresponsive.

If the person becomes unresponsive, they need CPR and emergency care (see Lesson 5). Techniques differ for infants and for pregnant or larger patients, which is one reason hands-on training matters.

Positioning: The Recovery Position

An unresponsive patient who is breathing normally and has no suspected spinal injury can be placed in the recovery position — rolled onto their side. This uses gravity to keep the tongue forward and lets fluids drain from the mouth rather than being inhaled, reducing the risk of choking while help arrives.

Supporting Breathing

When a patient has a pulse but is not breathing adequately, they may need rescue breathing — delivered breaths that inflate the lungs. Rescuers use a barrier device or bag-mask to protect themselves and to deliver breaths effectively; each breath should be just enough to make the chest visibly rise. If a patient has no pulse, rescue breaths alone are not enough and full CPR is required.

The Concept of Supplemental Oxygen

Room air is about 21% oxygen. Sick or injured patients often benefit from a higher concentration. EMS providers deliver supplemental oxygen through devices such as a nasal cannula (lower flow) or a non-rebreather mask (higher concentration) to raise the oxygen available to the lungs and, ultimately, the tissues. The goal is to correct low oxygen levels reflected in a low SpO2 reading.

Clinical Relevance

Airway problems are among the fastest killers in emergency care, which is why “A” comes first in the ABCs. A simple head-tilt/chin-lift can restore breathing in an unconscious person whose only problem is a fallen tongue, and prompt abdominal thrusts can dislodge food from a choking diner before oxygen levels fall dangerously. Recognizing the difference between mild and severe obstruction, choosing the right airway maneuver, and knowing when breathing needs support are foundational skills that make every later intervention possible.

Going deeper advanced

Extra depth for when you're ready — expanded automatically in Advanced mode.

Airway adjuncts: OPA and NPA

Basic adjuncts help hold the airway open when manual maneuvers are not enough. An oropharyngeal airway (OPA) is a curved device placed in the mouth that holds the tongue forward, but it is only tolerated by a deeply unresponsive patient with no gag reflex, or it can trigger vomiting. A nasopharyngeal airway (NPA) is a soft tube passed through the nostril and is better tolerated by patients who still have some response. Both are trained skills that supplement, not replace, correct head positioning.

Ventilation risks and monitoring

Positive-pressure ventilation with a bag-mask is lifesaving but easy to overdo. Squeezing too hard, too fast, or too much can force air into the stomach (gastric insufflation), which raises the risk of vomiting and aspiration and can splint the diaphragm, so each breath is given just until the chest gently rises. Pulse oximetry shows oxygenation but lags behind changes, whereas capnography measures exhaled carbon dioxide and confirms that ventilation is actually moving air, making the two measurements complementary.

Key terms

Airway
The passage through which air travels to and from the lungs, from the mouth and nose down to the bronchi.
Patent airway
An airway that is open and unobstructed, allowing air to move freely.
Head-tilt/chin-lift
A maneuver that opens the airway by tilting the head back and lifting the chin, used when no spinal injury is suspected.
Jaw-thrust
A maneuver that opens the airway by pushing the jaw forward without moving the neck, used when spinal injury is suspected.
Airway obstruction
A blockage of the airway by the tongue, a foreign object, fluid, or swelling.
Abdominal thrusts
Quick inward and upward thrusts below the ribs used to expel an object blocking the airway of a responsive choking adult.
Recovery position
A stable position on the side that helps keep the airway of an unresponsive, breathing patient clear.
Rescue breathing
Providing breaths to a patient who is not breathing adequately but has a pulse.

Check your understanding

6 questions · answers reveal instantly.

  1. 1.In an unresponsive patient with no suspected neck injury, the preferred way to open the airway is the:
  2. 2.Which maneuver is preferred when a spinal injury is suspected?
  3. 3.A responsive adult is choking, cannot speak or cough, and clutches their throat. You should:
  4. 4.The recovery position is used for a patient who is:
  5. 5.Rescue breathing is indicated when a patient:
  6. 6.Snoring or gurgling sounds from an unresponsive patient usually indicate:

Citations & References

Links open publicly available educational and peer-reviewed sources.

  1. American Heart Association: CPR & First Aid. ↗
  2. American Red Cross: First Aid & CPR. ↗
  3. MedlinePlus, U.S. National Library of Medicine. ↗