Assessment and maintenance of a safe and open airway remains the top priority in all acute situations.¹ Systematic assessment continues throughout the acute phase of deterioration and beyond, to enable recognition and prioritise management of ongoing and new problems. Once the airway is open it must be maintained effectively in order to ensure adequate ventilation for oxygenation of vital organs and tissues.

If the patient is unable to maintain a clear or safe airway independently, it should be opened using the techniques described in Chapter 8. If the airway is obstructed or at risk of obstruction due to blood, vomit or secretions, gentle oral suction should be applied using a wide bore oral suction device (Figure 9.1). When carrying out this procedure do not advance the catheter into the oropharynx as this causes gagging and vomiting, further compounding the problem.

Simple airway adjuncts such as the oropharyngeal airway (OPA) (Figure 9.2) and nasopharyngeal airway (NPA) (Figure 9.3) can be helpful in maintaining an open airway, but should only be inserted by healthcare staff who are trained and competent to do so. Once inserted they help maintain airway patency and are used in conjunction with the pocket mask or bag valve mask devices as an aid to ventilation as necessary.