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The first step in the management of airway obstruction (Fig 1) is to give 100 % oxygen via a face mask. Attempt airway manoeuvres such as chin lift (Fig 2 and Fig 3) and jaw thrust (Fig 4) in order to open up the airway. If this fails, call for help. Clear secretions or debris from the oropharynx and then insert an oral or nasal airway.

Try to reposition the head and attempt airway manoeuvres again. Apply mask CPAP. This can be achieved by closing the expiratory valve of the circuit and holding the mask with two hands to maintain a tight seal. If the patient is not breathing, an assistant can squeeze the bag to provide IPPV. If you suspect laryngospasm, consider a small dose of suxamethonium (e.g. 0.1 mg/kg).

This can sometimes act sufficiently to ‘break’ the spasm. If you are still unsuccessful, consider reintubating the patient using an induction agent plus suxamethonium.