Before effective ventilation can take place, the airway must be patent. This can be ensured in various ways, alone or in combination.
• Head tilt: tilt the head back gently to a neutral position in newborns, slightly extended in older children.
• Chin lift: using 1 or 2 fingers apply forward pressure to just under the chin to pull the tongue forward.
• Jaw thrust: apply forward pressure behind one or both angles of the jaw to pull the tongue forward.
• Guedel oro-pharyngeal airway: slip the airway over the tongue until the flange reaches the lips. Be careful not to push the tongue back. To determine the correct size, hold the airway along the line of the jaw with the flange in the middle of the lips. The end of the correctly sized airway should be level with the angle of the jaw.
• Endotracheal intubation:
• Suction: not routinely required, especially in newborn resuscitation. However, if the methods described above are not successful in obtaining an adequate airway, check that the airway is not obstructed by secretions, vomitus, blood, meconium, etc. If there is obstruction on inspection, or it is obvious from the start, suction should be performed using an appropriate suction catheter connected to a suction source.
• Tracheotomy: bypasses upper airway obstruction and when oral oro-nasal endotracheal intubation fails or is contraindicated. Perform only if already trained by a senior doctor.