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?

Upper airway obstructions affect the trachea, pharynx, or larynx. Though partial obstructions can be painful, complete obstructions can be life-threatening. Without treatment, they can quickly prove fatal. 

COVID-19 has fundamentally changed everything about how people live. As we face one of the world’s highest infection rates, many Americans remain quarantined in their homes. Choices that once seemed innocuous, such as going to the dentist or the grocery store, can now expose people to a lethal virus. 

Tachycardia can be a sign of respiratory distress. It can also be a complication of interventions to treat respiratory distress, including suctioning. First responders and medical providers must have a clear understanding of the link between tachycardia and suctioning so that they can reduce the risk of patient injuries and improve both long- and short-term outcomes.

Advanced airway management demands precision and skill, especially in vulnerable patients. When performed correctly, however, initiating nasopharyngeal airways is very safe—and much safer than the alternative of doing nothing. Many first responders are reluctant to initiate a nasopharyngeal airway, citing fears of complications. But this route can enable intubation in patients with an intact gag reflex. Proper training can promote greater confidence, so don’t let fear deter you from practicing this life-saving technique.

Airway obstructions are a common emergency, especially among pediatric and geriatric patients. Choking is a leading cause of childhood death and injury among children under the age of 4, claiming at least one child’s life every few days. The risk of airway obstructions due to chronic obstructive pulmonary disease (COPD), pneumonia, and airway injuries greatly increases with age. The airway also becomes more fragile as a person gets older, making it more difficult to treat airway issues. A number of techniques can open an obstructed airway, but the right technique depends on the reason for the obstruction. 

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.