Share the postThe Home Page for the Essential Emergency Airway Care Course (EEACC) at The Sharp End site contains links to each of the modules and those module links also contain the show notes and the references.
I only made this slide list so that I could quickly review EEACC#1 (This is the direct link to this video on Vimeo –You need to watch the video more than once). Founder and CEOAmongst her many talents and passions, Michellita would place fashion and modeling at the top of her list. Begin Your Journey Today!!Masterpieces Modeling is an equal opportunity company that provides training and course work to equip individuals for the entertaiment fields.
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I must confess, I’ve been one of the many providers who just went through the motions and “bagged” the life right out of my patients. This article will address the most basic of our airway maneuvers: opening and maintaining the airway.
The Problem is the Tongue!Providers are really good at trying to ensure the head is hyperextended in obtunded patients, but simply tilting the head back often does not remove the tongue from the post-oral pharynx. With the two-person approach, the provider responsible for opening and maintaining the airway has the distinct advantage of using both hands to exert enough pressure to move the mandible and tongue anteriorly. Once this has been achieved, you have to maintain that position throughout the time you are providing bag-mask ventilations. Of course, it’s important to use airway adjuncts (oropharyngeal or nasopharyngeal) to assist with maintaining the tongue’s anterior placement. I realize most EMS textbooks don’t go to this extent to describe this procedure, but I think they should. Once you open the airway and are ready to hold it open, use the following Difficult Airway Course: EMS-recommended hand positioning on the mask to ensure you maintain an open airway and mask seal at the same time. Although opening and maintaining an airway is taught in the earliest days of any EMT class, the importance of this critical skill is often not conveyed well, nor is the importance of this skill carried into daily practice.
Michael Keller is a curriculum faculty member at Gaston College, Department for EMS Education. But do we actually understand the physical dynamics of how to open an airway and keep it open for artificial ventilation?

I wish I had hard scientific evidence to support my belief, but unfortunately I only have 30 years of personal experience to rely on.
Please, for the good of our profession and the patients we serve, read it carefully and then begin employing the techniques we teach in The Difficult Airway Course: EMS.
To perform this action well, the first step is to open the mouth fully, then place the thenar pad (the area of the hand where your thumb attaches to the hand) on the zygoma (cheek). If sufficient pressure is not maintained to ensure the condylar process is kept forward of the TMJ, in the absence of some mitigating TMJ disorder, the mandible will move posteriorly back into place, reintroducing the tongue into the pharynx. Do not allow your thumbs to come across the bridge of the nose, as with the “double C & E” technique. Please consider the ideas and procedures of this article very closely and begin employing these concepts into your daily practice. I can recall far too many cases where I arrived to hear the dreaded sound of air blowing out around the mask of the bag-valve device.
The tongue is securely fastened to the mandible and by moving the mandible anteriorly, the tongue will follow and prevent obstruction of the pharynx. The most important aspect of maintaining the open airway is ensuring the mandible and tongue are pulled forward. Most providers do not understand the extent and force it takes to move the tongue and maintain the open airway. A well-executed jaw thrust moves the mandible, tongue and, by association, the epiglottis anterior and opens the airway. As a profession, we need to do a better job of maintaining airways and appropriately ventilating the pulmonary fields, while minimizing gastric inflation. Michael Murphy and a wonderful CRNA named Judy Leftwich brought reality crashing down on me.
The problem becomes applying enough force under the chin to adequately move the mandible, and thus the tongue, anteriorly. Now, apply significant anterior pressure to ensure you move the head of the mandibular condylar process out of the temporomandibular joint (TMJ).
Instead, run your thumbs down the mask and allow your fingers to fall into position to pull the jaw anteriorly into the mask.

He is a founding faculty member and the southeast regional course director for The Difficult Airway Course: EMS. Notice I say every three to four seconds; that’s because we know hyperventilation is a problem, but it’s a topic better left for another article. The often-performed one-man BVM with C&E technique is very hard to perform, and even harder to master. In other words, nearly dislocate the jaw, which is called ‘translating’ the mandible anteriorly. I want you to watch the following two videos to see how a well-placed jaw thrust will ensure your patient’s airway is open.The first video is a lateral fluoroscope of an airway being manipulated.
It is critically important to pull the jaw up into the mask, not push the mask down onto the jaw. Even if we’re able to move the mandible with one-hand, maintaining that forward position is a daunting task, especially during prolonged artificial ventilation. This procedure, although it sounds dramatic, will ensure the mandible and tongue are sufficiently moved forward to make certain the pharynx is unobstructed.
This position allows for a much more secure and comfortable position for prolonged ventilations.
For these reasons, we at The Difficult Airway Course: EMS, strongly encourage all agencies to dedicate two providers to airway management when providing bag-mask ventilations. Watch as the jaw is pulled forward and you’ll see the tongue move forward out of the pharynx, and the bright backlight will shine through showing what we hope to achieve. Unfortunately, even though we teach the jaw lift with the head tilt, more often than not patients are only afforded the hyperextension.
Now, at about 10 seconds into the video, watch very carefully as a proper jaw thrust is performed.

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