Head-tilt-chin-lift is contraindicated in which scenario?

• A. Facial trauma without spinal injury
• B. Unresponsive patient without gag reflex
• C. Apneic patient with obstruction
• D. Suspected cervical spine injury

Answer: (D)

The key idea here is protecting the cervical spine during airway management. The head-tilt-chin-lift maneuver opens the airway by tilting the head back and lifting the chin, which moves the neck into extension. If there’s a suspected cervical spine injury, any movement of the neck can worsen the injury or cause more damage to the spinal cord. That’s why this technique is contraindicated in that scenario. In those cases you keep the neck in a neutral position and use a jaw-thrust maneuver with inline stabilization (often with a bag‑valve mask for ventilation) to open and maintain the airway without moving the spine.

The other situations don’t carry the same absolute risk of neck movement. For example, unresponsive patients without a gag reflex are commonly ventilated with head-tilt-chin-lift to open the airway, and airway obstruction is addressed with appropriate obstruction management and ventilation as needed. Facial trauma can complicate airway management, but the decisive factor here is whether cervical spine injury is suspected.