• To identify and remove a suspected foreign body from the hypopharynx that is preventing ventilation.
  • In order to create a patent airway and an ability to achieve adequate ventilation
  • Conscious patient or Gag reflex intact
  • Do not use Magill forceps if obstruction below the vocal cords.
  • SpO2 reading of 90% and ventilation is achievable
  • Suspected epiglottitis.
Patient Factors & Considerations
  • Damage to upper respiratory tract, lips and teeth/dentures.
  • Further impaction or crumbling of the foreign body
  • Vagal stimulation
  • Exacerbation of hypoxia / hypercapnia.
  • Spinal injury.
  • All relevant infection control methods to be utilised.
  • Prepare equipment required:
    • Laryngoscope
    • Magill forceps
    • Bag Valve Mask (BVM)
    • Oxygen Suction

Direct Laryngoscopy is a dynamic process that should start with properly positioning the patient in the Sniffing Position, but may require further position adjustment to achieve the required views.

N.B.:  In cardiac arrest due to foreign body airway obstruction, direct laryngoscopy & removal of foreign body MUST occur in conjunction with high quality chest compressions. Delayed ventilation (i.e. OPA/NPA with a non-rebreather mask) must NOT occur and ventilation must be commenced as soon as practicable.

  1. Position the patient for optimal visualisation of the larynx (e.g sniff or pillow support)
  2. Open patient’s mouth by use of the cross finger technique, inspecting the oral cavity.
  3. Suction if required
  4. If the obstruction is visible and can be removed with the Magill forceps, proceed to Step 7.
  5. Using left hand, place the laryngoscope blade into the right side of the patient’s mouth, gently sweep the tongue to the left and position the blade midline in the mouth. Ensure any obstructions are not pushed further down the respiratory tract.
  6. Advance the blade progressively down the tongue, exposing the obstructing object.
  7. Insert the Magill forceps from the right side of the laryngoscope, ensuring the tips of the forceps are clearly visible at all times.
  8. Grip the object in a scissor like action, dislodge it with gentle side to side motion and remove it gently.
Laryngoscope1 Laryngoscope2
  • Continue airway management as required.
Additional Information

El-Orbany, M., Woehlck, H. and Ramez Salem, M. (2011) Head and neck position for direct laryngoscopy. Anaesthesia and Analgesia. 113 (1) 103-109.

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