Head Tilt-chin Lift Research Articles

Comparison of Three Airway Maneuvers of Jaw Thrust, Two-Handed E-C Technique With Head in Neutral Position, and Two-Handed E-C Technique With Head Fully Extended: A Prospective, Randomized, Double-Blind Crossover Study.

Background Bag-mask ventilation is an essential life-saving skill. The E-C technique of mask holding is the most popular. In patients with suspected cervical injury, the jaw thrust maneuver is recommended instead of the E-C technique with head tilt-chin lift. Should jaw thrust fail to produce adequate chest rise, the operator is advised to switch to the E-C technique with the head tilt-chin lift maneuver with head extension as it is vital to move oxygen into the lungs. We hypothesized that the E-C clamp with the head in the neutral position without head tilt might permit adequate ventilation without producing excessive movement of the cervical spine, which in turn might translate as less strain to the cervical spine. Methods In this prospective, randomized, double-blind, crossover study, we evaluated the relative efficacy of three airway maneuvers in opening the airway in anesthetized and paralyzed adults: jaw thrust, two-handed E-C technique with head in the neutral position, and two-handed E-C technique with head fully extended. The tidal volume generated during mechanical ventilation using these three techniques was considered as the primary outcome. Seventy-two subjects were recruited for this trial and all three techniques of mask holding were performed in each of these subjects in a sequence as dictated by a randomization table. Results The jaw thrust technique provided a mean tidal volume significantly higher than the two-handed E-C technique, with the head in the neutral position (p<0.001). Similarly, the two-handed E-C technique with the head fully extended provided a mean tidal volume significantly higher than the two-handed E-C technique with the head in neutral position (p<0.011). The mean tidal volume obtained with jaw thrust and two-handed E-C technique with head fully extended were comparable (p=0.78). Conclusion The two-handed E-C technique with the head fully extended, and the jaw thrust technique both produce good and comparable tidal volumes. The two-handed E-C technique with the head in a neutral position provides adequate though lower tidal volumes as compared to the other two techniques.

Potential to enhance telephone cardiopulmonary resuscitation with improved instructions - findings from a simulation-based manikin study with lay rescuers

BackgroundTelephone-Cardiopulmonary Resuscitation (T-CPR) significantly increases rate of bystander resuscitation and improves patient outcomes after out-of-hospital cardiac arrest (OHCA). Nevertheless, securing correct execution of instructions remains a difficulty. ERC Guidelines 2021 recommend standardised instructions with continuous evaluation. Yet, there are no explicit recommendations on a standardised wording of T-CPR in the German language. We investigated, whether a modified wording regarding check for breathing in a German T-CPR protocol improved performance of T-CPR. MethodsA simulation study with 48 OHCA scenarios was conducted. In a non-randomised trial study lay rescuers were instructed using the real-life-CPR protocol of the regional dispatch centre and as the intervention a modified T-CPR protocol, including specific check for breathing (head tilt-chin lift instructions). Resuscitation parameters were assessed with a manikin and video recordings.ResultsCheck for breathing was performed by 64.3% (n = 14) of the lay rescuers with original wording and by 92.6% (n = 27) in the group with modified wording (p = 0.035). In the original wording group the head tilt-chin manoeuvre was executed by 0.0% of the lay rescuers compared to 70.3% in the group with modified wording (p < 0.001). The average duration of check for breathing was 1 ± 1 s in the original wording group and 4 ± 2 s in the group with modified wording (p < 0.001). Other instructions (e.g. check for consciousness and removal of clothing) were well performed and did not differ significantly between groups. Quality of chest compression did not differ significantly between groups, with the exception of mean chest compression depth, which was slightly deeper in the modified wording group.ConclusionCorrect check for breathing seems to be a problem for lay rescuers, which can be decreased by describing the assessment in more detail. Hence, T-CPR protocols should provide standardised explicit instructions on how to perform airway assessment. Each protocol should be evaluated for practicability.

Dental sedation—Airing a concept

AbstractAimTo establish current practices and experiences of dental practitioners, who are carrying out procedures under sedation in primary care, relating to assessment and management of the airway. We also review current recommendations and consider a need for further clinical guidance to standardise practice.MaterialsThe survey was created using Survey Monkey and distributed through social media channels such as WhatsApp, Facebook and via emailing a local sedation group.MethodsA service evaluation was carried out in the form of an online survey. This was distributed via social media and by emailing previous and current attendees of Dental Sedation Courses. This link remained active for 3 months with a minimum target of 50 completed responses. During this period, a total of 64 responses were received.Results51 of 64 respondents stated they complete airway assessments, of which, less than half used a pro‐forma for this purpose. Within this cohort, 21.9% of respondents acknowledged a compromised airway incident requiring initial management, with the most favoured adjunct/manoeuvre being a head tilt chin lift of the patient.ConclusionAs sedation operators, dentists carry the responsibility for the provision of dental treatment alongside the management of the airway. Conscious intravenous sedation is usually carried out using midazolam, a short acting and amnesic benzodiazepine. Whilst this is widely used, risks such as respiratory depression or loss of the airway remain. To prevent this, it is vital for an airway assessment to be carried out pre‐operatively as echoed by the Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) and Scottish Dental Clinical Effectiveness Programme (SDCEP). This article highlights the need for guidance to support general dental practitioners in the pre‐operative assessment of airways to further streamline and improve patient care.

A distance education experience on assessment of airway maneuvers during COVID-19 pandemic

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic has necessitated the switch to distance education by abandoning face-to-face education worldwide. This study aimed to investigate whether it is possible for practical education and performance measurements through distance education.&#x0D; Methods: The application video and the application steps were sent to the participants through their smartphone by WhatsApp messenger. Grade 1 students in the Physiotherapy Section (Group A) and Grade 1 students in the Paramedic Section (Group B) voluntarily participated in the study. The participants were asked to apply simulation applications and record the simulation applications' video clips with their smartphones.&#x0D; Results: The mean age of the 123 participants was 20.11 ± 2.03 (18-33) years, and 56 (45.5%) were in Group A, and 67 (54.5%) were in Group B. While the participants in Group A were successful at a rate of 35.7% (n = 20) in the head tilt-chin lift maneuver, this rate was 65.7% (n = 44) for Group B (p = 0.001). For the jaw thrust maneuver, the success rate was 21.4% (n = 12) for Group A and 31.3% (n = 21) for Group B.&#x0D; Conclusion: In this study, the participants used family members as a live simulation model in our research. The participants who were given face-to-face education before were more successful on head tilt chin lift maneuver. Jaw thrust maneuver was more challenging to learn and practice by distance education. The academicians interested in medical education should keep in mind that the outcomes of the COVID-19 pandemic have permanent effects on education systems.&#x0D; Ibrahim Med. Coll. J. 2021; 15(1): 1-8

Changes in peak expiratory flow rates using two head-tilt/chin-lift maneuver angles in young healthy conscious volunteers.

BackgroundThe head-tilt/chin-lift (HT/CL) maneuver is simple and routinely used to open a closed upper airway.ObjectivesIt has yet to be determined whether increasing the HT/CL angle further would be beneficial.MethodsWe enrolled 60 (30 males) 20-year-old conscious participants. Pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were defined as positions in which the angle between the ear–eye line and the horizontal line was 80°, 65°, and 50°, respectively. Peak exploratory flow rates (PEFRs) pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were recorded continuously at 1-minute intervals (one set). Five sets of measurements were performed (total, 15 measurements for each participant).ResultsWe analysed 900 measurements (180 sets). The mean PEFRs pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions were 348.4 ± 96.9, 366.4 ± 104.9, and 378.8 ± 111.2 L/min (percentage change compared to pre-HT/CL, 5.2% and 8.7%), respectively. Significant differences were observed among pre-HT/CL, post-HT/CL #1, and post-HT/CL #2 positions in all participants, as well as in subgroup classified according to sex, and medians of height, body weight, and body mass index.ConclusionOur findings suggest that a greater HT/CL angle would be beneficial, as the PEFR increased gradually. The decreasing manner in the PEFR increase with the HT/CL angle implies the existence of an angle threshold beyond which there were no further benefits in airflow, indicating a minimum in airway resistance. A HT/CL maneuver may be appropriate until locking the atlanto-occipital and cervical spine joints in extension occurs and the chest (sternal notch) begins to rise.

Bag-Valve-Mask Ventilation After Induction for Intubation: PreVenting Hypoxemia?: July 2019 Annals of Emergency Medicine Journal Club

Bag-Valve-Mask Ventilation After Induction for Intubation: PreVenting Hypoxemia?: July 2019 Annals of Emergency Medicine Journal Club

Change in peak expiratory flow rate after the head-tilt/chin-lift maneuver among young, healthy, and conscious volunteers.

ObjectiveThe head-tilt/chin-lift (HT/CL) is a simple, routinely used maneuver to open the upper airway. Changes in the peak expiratory flow rate (PEFR) before and after the HT/CL maneuver have not been evaluated among conscious volunteers who are regarded as a control cohort.MethodsSixty healthy 20-year-old volunteers (30 males and 30 females) were enrolled. The supine position was defined as the position at which the ear-eye line was at a 10° angle to the horizontal. The HT/CL position was defined as the position at which the ear-eye line was at a 25° angle to the horizontal. PEFR was measured using a hand-held device with the subject in the supine position (pre-PEFR) and HT/CL position (post-PEFR), respectively. One set was defined as these two measurements. Five sets of measurements were performed on each subject (300 sets). The set with the maximal and minimal difference between pre-PEFR and post-PEFR were excluded from the analysis. We used a paired t-test to compare the mean pre-PEFR and post-PEFR values for the entire group and subgroups divided by sex, height, body weight, body mass index and response status.ResultsOverall, 360 measurements (180 sets) were analyzed. The mean pre-PEFR and post-PEFR were 316.1±87.6 and 346.5±94.7 L/min, respectively. Further, significant differences were observed for sex, height, body weight, and body mass index. In 10 subjects, post-PEFR was lower than pre-PEFR.ConclusionPEFR increased by 9.6% after the HT/CL maneuver in young conscious subjects, but some subjects showed decreased PEFR after the HT/CL maneuver.

Ability of managing medical emergencies in dental setting among the interns and faculty of a dental college in Mangalore

Aim: To explore the perceptions, concerns, and experiences of interns and staff after their accident and emergency posting in a dental institution. Objective: •z To evaluate the knowledge and awareness of Medical emergencies among the interns and staff in a dentainstitution. •z To comparatively evaluate the knowledge and awareness of Medical emergencies among the staff and interns of the institution. Material and Method: A cross sectional questionnaire study was conducted in a DCI (Dental Council of India) recognized college. The data was collected using questionnaire method regarding the awareness and knowledge of medical emergencies among the interns and staff of a dental institution. Data Collection: Questionnaires were introduced to the participants regarding the awareness and knowledge of medical emergencies after obtaining the informed consent. 155 questionnaires were distributed to the respondents of a dental college were included for this study. Statistical Analysis: Descriptive statistics were tabulated. Chi-square tests were applied for this study. Results: Only 53.2% among the staff respondents had attended a training program in BLS, whereas 86.6% of the interns had attended a training program in BLS. All the interns (100%) knew about the abbreviation of BLS. 96.8% of the staff aimed at the need of BLS training in the dental curriculum. 95.1% of the interns, and 88.7% of the staff were able to provide the right option on the signs of airway obstruction. 90.2% of the interns and 77.4% of the staff gave the right option of head tilt-chin lift maneuver to open the airway during obstruction. Conclusion: Awareness of BLS among the staff and interns was not upto the mark, and hence it is now essential to make it mandatory in the field of dentistry for both undergraduate and postgraduate curricula.

The effectiveness of using medical students for training high school students in cardiopulmonary resuscitation

Abstract Introduction: Training for cardiopulmonary resuscitation is a very important topic for society, trainers and researchers. However it is not yet established who should be trained and by whom nor how the training programmes should be accomplished. We developed a study to evaluate an existing programme where medical students train high school students in cardiopulmonary resuscitation using instrumented mannequins to teach and collect performance data. Method: The students of four randomly selected high school classes were trained by four randomly selected medical students and were evaluated by an independent evaluator. The level of knowledge provided and the level of technical skills acquired were analysed. Results: One hour of lecturing was enough to increase the mean of correct answers from 39.52% to 78.48% when we tested knowledge. Testing for skills retention we found that that 92.75% of trained students taped the shoulder; 95.65% asked loudly “Are you all right?” at the right moment; 97.1% shouted for help at the right moment, the entire group remembered to check the breathing at the right moment, and 92.75% executed a correct head tilt chin lift manoeuvre; 86.9% remembered to call 112 at the right moment. Automatic recordings showed that mean flow fraction was 80.74%, mean no flow time was 18.9 seconds, mean frequency of chest compressions was 134.7/min and mean compression depth was 39.06 mm. Conclusions: The results showed that high school students achieved a good level of knowledge and acceptable cardiopulmonary resuscitation skills when trained by medical students.

A influência das manobras de suporte das vias aéreas sobre a visibilidade da glote em fibrobroncoscopia pediátrica

IntroductionFlexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy. Materials and methodsIn this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I‐II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded. ResultsTotal of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p<0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p>0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p<0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p>0.05). ConclusionAll airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers.

The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy

IntroductionFlexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy. Materials and methodsIn this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I–II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded. ResultsTotal of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p<0.05), but we did not observe any difference between jaw trust with open mouth and jaw trust with teeth prottution maneuvers (p>0.05). Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p<0.05); however we found no differences between head tilt chin lift and triple airway maneuvers (p>0.05). ConclusionAll airway supporting maneuvers improved glottic view during pediatric flexible fiberoptic bronchoscopy; however head tilt chin lift and triple airway maneuvers were found to be the most effective maneuvers.

Motion generated in the unstable upper cervical spine during head tilt–chin lift and jaw thrust maneuvers

Background contextAlthough it is essential to maintain a secure airway in a trauma patient, it is also critical to protect the potentially injured cervical spine. It has previously been suggested that the jaw thrust maneuver be used in place of the head tilt–chin lift in the suspected spine-injured patient. PurposeWe sought to examine whether the jaw thrust was in fact safer to use in the setting of an unstable upper cervical spine injury. MethodsUnstable, dissociative C1–C2 injuries were surgically created in nine fresh, lightly embalmed human cadaver specimens. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment. Measurements were recorded during execution of the two airway maneuvers. Trials were performed both with and without a cervical immobilization collar in place. ResultsThere was almost twice as much angular motion in all planes when performing a head tilt–chin lift as compared with the jaw thrust, and this was statistically significant (p<.013). In addition, there was more displacement at the injured level with a head tilt–chin lift as compared with the jaw thrust. This was statistically significant for axial displacement and anteroposterior translation (p=.003 for both), and approached significance for mediolateral translation (p=.056). ConclusionsThe jaw thrust maneuver results in less motion at an unstable C1–C2 injury as compared with the head tilt–chin lift maneuver. We therefore recommend the use of the jaw thrust to improve airway patency in the trauma patient with suspected cervical spine injury.

A New Technique for Jaw Thrust in Unconscious Craniofacial Trauma Patients

The loss of consciousness is one of the commonly encountered emergency situations in maxillofacial trauma patients. Apart from benign syncope, there are other causes for unconsciousness. Majority of these patients have intact respiratory muscle activity, but the airway patency is compromised due to airway obstruction by tongue fall back. Traditionally head tilt-chin lift and jaw thrust techniques were employed to maintain patency of the airway. Head tilt-chin lift technique involves tilting the head backward and thus is dangerous in case of suspected cervical spine injury in trauma cases. Jaw thrust is an efficient method and can be performed in cervical spine injury cases. But it requires continuous forward pull on mandible till the time patient regains consciousness; which is physically strenuous for rescuer. The purpose of this article is to present a new technique for jaw thrust which is based on similar principle of traditional jaw thrust. The advantage is that, jaw thrust can be maintained for an extended time period in these patients.

Airway compression after arthroscopic shoulder surgery under general anesthesia

Airway compression after arthroscopic shoulder surgery under general anesthesia

First aid competition in Spanish Red Cross: An indicator of quality of training in cardiopulmonary resuscitation

The Spanish Red Cross organises an annual national competition for teams. Different tests asses the knowledge and skills of each participant. Objective: To have an indicator of the knowledge and skills in Basic Life Support of our first aiders, by using individual evaluation sheets. Materials and methods: We analyze the results of 60 participants, with knowledge on basic first aid. Health professionals are excluded. We asses two cases, an adult who suffers a sudden cardiac arrest and an infant with a foreign body airway obstruction. Both tests are evaluated by instructors and supervised by a doctor. Materials and place for an adequate cardiopulmonary resuscitation (CPR) are provided. Every participant has four minutes for each case. Adequate information is given interactively. Ressuci Anne full body and Baby Anne Laerdal dolls are used. Results are reported to teams. Results: Adult: Correct Safety measures (CSM): 50%. Shout for help after unconsciousness: 65%. Activate immediately 112/AEDs after apnoea: 80%. CPR correct position: 33.3%. Head tilt-chin lift (73.3%). Verify apnoea for 5-10”, 83.3%. Do not identify cardiac arrest: 3.3%; Pulse palpation: 10%. Compressions in the centre of chest: 89.6%. Adequate compression pressure: 91.4%. Rate: 90–110’: 71.6%. Ratio 30/2: 96.5%. Infant: CSM: 55%. Shout for help if Ineffective coughing 18.3%. Verify foreign body presence 76.6%. Attempt blind sweep: 5%. Correct back blows and chest thrusts: 40%. Call “112” after unconsciousness: 66.6% and initiate CPR: 93 3%, starting with 5 rescue breaths 71.6%, and using arm for CPR 33.3%. Conclusions: The exercise shows some important weakly points, like the need to improve the self-protection systems, the adequate call for help, the position of CPR in infant… We believe that this analysis can serve as an indicator of the quality of the training of our volunteers and can allow us to improve our CPR training.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Ecstasy toxicity and the cooling factor

A rapid response unit (RRU) and ambulance were dispatched to a young adult reported to be fitting at the site of a “rave”. On arrival, the patient was being treated...

Jaw lift—a simple and effective method to open the airway in children

Assessment of breathing during resuscitation of children is important. Misjudgement due to failure to open the airway may lead to mouth-to-mouth ventilation in unconscious children who have retained spontaneous breathing efforts, and might lead to completely ineffective ventilation with gastric distension. The efficiency of the standard head tilt-chin lift manoeuvre (HT-CL) and the jaw lift manoeuvre (JL) for opening of the airway in children was investigated. Fifty children between 1 and 9 years of age breathing spontaneously during deep anaesthesia were studied. Both manoeuvres were randomly performed in all children by nurse anaesthetists. The time for opening and the quality of the airway was determined by a blind folded anaesthesiologist listening to the breathing sounds. The standard HT-CL manoeuvre was insufficient in 12% of the children. JL was more effective than HT-CL in opening the airway in unconscious children who had retained attempts at spontaneous breathing. The JL manoeuvre may, therefore, be recommended in situations when the HT-CL manoeuvre is insufficient.