• Head tilt chin lift (jaw thrust if C spine concerns)

• Visualise airway; foreign body? Can you safely remove?

• Consider suction if needed

• Consider senior support for advanced suction/possible foreign body removal

• Correctly sized OPA – front teeth to angle of the jaw

• Correctly sized NPA (adults only)

• SILO the patient (if tolerated)

• Utilise tongue depressor for paediatrics

• Lube NPAs first, twist to aid insertion but withdraw if twist is not successful – DO NOT FORCE

• Utilise 2 handed TE grip where possible – CE grip if not

• Ventilate to minimal chest rise (over 1/3 of the bag for 100kg adults)

• 1 breath every 6 seconds (for adults – ‘page for age’ for paediatrics)

• DO NOT over-ventilate or over-bag – to avoid inflating the stomach

• In arrest – upgrade to i-gel as soon as possible

• Check airway prior to insertion – is suction needed? Foreign body?

• Anticipate difficult airway:

R - Restricted mouth opening

O - Obstruction

D - Disrupted or Distorted airway

S - Stiff lung or C spine

• i-gel and simple adjuncts fail – no air entry, no chest rise

• Manage as best as possible to achieve air entry

• Call immediate senior support and update 999 for failed airway – request ‘critical care support’

• Maintain oxygen therapy and keep the airway open

• Continue ventilating or assisting the patient with supplemental ventilations to maintain RR>10

• Avoid causing barotrauma by not over ventilating, particularly on inhalation

• If the patient no longer tolerates the airway, consider removing it – consider cascading down to simple adjuncts and supplemental BVM if they can tolerate it and it is required