Ah, airway obstruction—the ultimate medical emergency where your patient’s body suddenly decides that oxygen isn’t a priority anymore. Whether it’s from choking, trauma, swelling, or the ever-dramatic tongue-in-the-way scenario, a blocked airway is an immediate life-threatening problem that needs fast, decisive action.
Because let’s face it—if air isn’t getting in, nothing else matters.
Let’s break down what causes an airway blockage, why it’s deadly in PHTLS, and how to fix it fast.
What Is a Blocked Airway?
A blocked airway is exactly what it sounds like—something is obstructing airflow into the lungs. No airflow = no oxygen = hypoxia, brain damage, and death within minutes.
There are two main types of airway obstruction:
🔹 Partial Obstruction (Air Still Moving, But Poorly)
🛑 Stridor (high-pitched wheezing) – Common in upper airway obstruction (e.g. swelling).
🛑 Gurgling or snoring sounds – Suggests fluid, tongue, or relaxed airway muscles blocking the path.
🛑 Coughing, gasping, or clutching at the throat – Typical of mild choking cases.
🔹 Complete Obstruction (No Air Moving = No Oxygen = Immediate Emergency)
🚨 Silent choking (no air movement, no sound, panic in the eyes).
🚨 Cyanosis (lips and face turning blue—hypoxia is setting in).
🚨 Unconsciousness (game over if not fixed FAST).
What Causes an Airway Blockage?
A blocked airway can happen for many reasons, but the biggest culprits in PHTLS include:
1️⃣ Foreign Body Airway Obstruction (Choking)
Food (especially in elderly patients, kids, and drunk people).
Dentures (yes, loose teeth can be lethal).
Toys, coins, or small objects (kids love swallowing things).
2️⃣ Trauma-Related Obstruction
Facial fractures (blood, swelling, or broken jaw shifting backwards).
Direct airway trauma (penetrating neck wounds, crushed trachea, or burns).
Swollen tongue (often post-seizure or unconscious patient).
3️⃣ Anaphylaxis & Severe Swelling
Allergic reactions (throat swelling from anaphylaxis).
Severe infections (epiglottitis, quinsy, or Ludwig’s angina).
4️⃣ The Infamous "Floppy Tongue Syndrome"
Unconscious patients lose muscle tone → tongue falls back & blocks the airway.
Common in head injuries, overdoses, and cardiac arrest.
Why Is a Blocked Airway a Problem in PHTLS?
In prehospital trauma life support (PHTLS), an obstructed airway immediately threatens life and needs instant correction.
🚑 The Airway = Priority Number One
1️⃣ Without oxygen, the brain dies in 3-5 minutes.
2️⃣ No airway = no ventilation = no circulation = no survival.
3️⃣ If an unconscious trauma patient has no clear airway, they will rapidly go into cardiac arrest.
This is why airway control always comes first in <C>ABCDE—without it, nothing else matters.
How to Manage a Blocked Airway in PHTLS
Your approach depends on what’s causing the obstruction. Recognising the type of blockage will determine how you fix it.
1️⃣ Choking (Foreign Body Airway Obstruction)
If your patient is conscious but choking, follow the UK Resuscitation Council’s algorithm:
1️⃣ Encourage coughing – If they can cough forcefully, let them clear it themselves.
2️⃣ 5 Back Blows – Lean them forward and deliver firm slaps between the shoulder blades.
3️⃣ 5 Abdominal Thrusts (Heimlich Manoeuvre) – Stand behind, fist under the sternum, and thrust upwards.
4️⃣ Repeat if needed.
5️⃣ If unconscious – Start CPR immediately (chest compressions may dislodge the object).
For Pregnant or Obese Patients:
Swap abdominal thrusts for chest thrusts (higher up on the sternum).
2️⃣ Trauma-Related Airway Obstruction
For trauma patients, a blocked airway can be due to injury, swelling, or tongue obstruction.
✅ Jaw Thrust (Best for Trauma Patients)
If the patient is unconscious but breathing, perform a jaw thrust instead of a head tilt (to avoid spinal movement).
✅ Suction Any Blood/Vomit/Mucus
If the airway is full of fluids, grab a Yankauer suction catheter and clear it ASAP.
✅ Manual Airway Opening
If the tongue is blocking the airway, try a chin lift or reposition the head slightly.
✅ Consider an NPA/OPA
Nasopharyngeal Airway (NPA): Best for semi-conscious patients who still have a gag reflex.
Oropharyngeal Airway (OPA): Best for fully unconscious patients with no gag reflex.
❌ Avoid OPAs in patients with an intact gag reflex—unless you enjoy watching them vomit.
3️⃣ Anaphylaxis & Swelling (Airway About to Close)
If the patient has airway swelling from anaphylaxis:
🚨 Immediate IM Adrenaline (Epinephrine) 500mcg (0.5ml 1:1000) into the thigh.
🚨 Give Oxygen (High-Flow via Non-Rebreather Mask).
🚨 Consider Nebulised Adrenaline to reduce swelling.
🚨 Prepare for Rapid Deterioration – Have an airway kit ready for intubation or cricothyroidotomy if needed and trained to use.
4️⃣ Unconscious Patient (Tongue Obstruction)
A floppy tongue is one of the most common causes of airway blockage in trauma, overdoses, and cardiac arrests.
✅ Jaw Thrust First.
✅ Consider an NPA or OPA to keep the airway open.
✅ If they start vomiting, roll them into the recovery position and suction as needed.
If the patient stops breathing and the airway is still blocked → Consider supraglottic airway (SGA) or endotracheal intubation if trained.
5️⃣ Last Resort: Surgical Airway (Cricothyroidotomy)
🚨 For complete airway obstruction where nothing else works (e.g. massive trauma, anaphylaxis with total swelling):
Cricothyroidotomy is your last option.
Only perform if trained and within scope of practice.
Final Thoughts
A blocked airway is one of the fastest ways a patient can die—so you need to act fast and decisively.
🚑 Key Takeaways for PHTLS Medics:
✅ Recognise the type of obstruction (Choking, Trauma, Anaphylaxis, or Tongue Blockage).
✅ For choking → Back blows, abdominal thrusts, CPR if unconscious.
✅ For trauma → Jaw thrust, suction, NPAs/OPAs, positioning.
✅ For anaphylaxis → IM Adrenaline, oxygen, airway kit ready.
✅ For unconscious patients → Airway adjuncts, positioning, suction.
✅ If all else fails → Prepare for advanced airway or cricothyroidotomy.
🚨 Remember: No airway = No oxygen = No life. Fix it fast, and you’ll save lives.
Stay safe, Kraken Medics – and always keep the airway clear! 🚑🔥
Further Reading & Useful Resources
🔹 UK Resuscitation Council: Choking Algorithm
🔹 NICE Guidelines: Airway Management in Trauma
🔹 RCEM: Advanced Airway Management
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