It’s a dramatic plot twist in movies, medical dramas, and even the occasional sitcom: a character is choking or in respiratory distress and standard interventions like the Heimlich maneuver just aren’t cutting it. So a heroic bystander takes things into their own hands and jams a pen into the victim’s throat, much to everyone’s horror. But then, to everyone’s shock and relief, doing so clears the airway, allowing the survivor to breathe until help arrives. But can you really do this? 

Early training in airway management usually focuses on the easy cases. Even as you graduate to working on the difficult airway, classroom training can’t fully prepare you for the many challenges emergency care will throw at you. You may have to tend to patients who are angry and combative, manage delicate airways in frigid cold or dangerous heat, treat patients in unsecured settings, and help people with dementia, developmental delays, or severe mental illness to understand the process of airway management. These tips can help you maintain a patent airway even in challenging situations. 

Airway obstructions are common and may even be underreported. The prevalence and type of airway obstruction varies with age. Children younger than 4, for example, are more vulnerable to choking-related upper airway obstructions, and adults commonly experience airway obstruction caused by complications from smoking. First responders will inevitably encounter a wide variety of airway obstructions and must be prepared to promptly respond to each with appropriate medical care. Here are the most common causes of upper airway obstruction. 

Age, weak muscle tone, chronic illnesses, and changes in the throat and esophagus increase the rate of airway obstructions in the elderly. A 2010 study that used spirometry measures as a clinical indicator of airway obstructions in patients aged 60-93 found an obstruction rate of 22.5 percent. This suggests that many elders live with partial obstructions that compromise overall function and health. When they experience an injury or illness, it’s easy for a partial obstruction to become a life-threatening full obstruction. Here’s what you need to know.

When patients die during or after an aspiration event, it’s often because of the exposure to airway contaminants, not hypoxia. The risk of death increases with the volume of fluid inhaled. This is why diligent, intelligent suction can prove life-saving, especially in someone with limited mobility who is actively aspirating or vomiting. The right suction device quickly clears airway obstructions with a high rate of flow and powerful suction.