In which scenario is the head-tilt-chin-lift maneuver contraindicated?

• A. In patients with gag reflex present
• B. In all patients
• C. In patients with suspected cervical spine injury
• D. In patients with a sore throat

Answer: (C)

The head-tilt-chin-lift opens the airway by extending the neck and lifting the chin to move the tongue away from the airway. This neck movement can worsen an unstable cervical spine, so it is contraindicated when there is suspected cervical spine injury. In that scenario, you keep the neck in line with manual stabilization and use the jaw-thrust maneuver to open the airway without moving the spine.

The other situations listed don’t require avoiding neck movement in the same way, so they’re not contraindications. Gag reflex presence or a sore throat doesn’t mandate stopping this maneuver, though you’d manage gagging or risk of aspiration accordingly and consider alternatives if needed.