Airway Assessment and Management - NREMT: EMT Level

About $1$ breath every $6$ seconds (≈$10$/min). This rate provides sufficient minute ventilation (about 5-6 L/min) while avoiding hyperventilation and gastric distension in apneic adults.

About $1$ breath every $3$–$5$ seconds (≈$12$–$20$/min). Higher rates accommodate the faster respiratory needs and smaller lung volumes of pediatric patients, preventing hypoventilation without causing barotrauma.

Visible chest rise. It confirms effective air delivery to the lungs without overinflation, guiding proper volume to avoid gastric insufflation or barotrauma.

Open the airway (jaw-thrust or head tilt–chin lift). These maneuvers displace the tongue anteriorly, relieving the most common cause of upper airway obstruction in unconscious patients due to muscle relaxation.

Perform abdominal thrusts. Abdominal thrusts generate intra-abdominal pressure to expel foreign bodies from the airway in conscious patients unable to cough effectively.

Begin CPR; check mouth for object before ventilations. CPR compressions may dislodge the object, with mouth checks ensuring removal before ventilation attempts to prevent pushing it deeper.

Poor chest rise with slow, shallow, or irregular breathing. These signs indicate insufficient tidal volume and rate, distinguishing from pure oxygenation issues where chest movement may be normal but gas exchange impaired.

Ability to speak in full sentences clearly. Clear speech indicates unobstructed airflow through the vocal cords and upper airway, confirming patency without invasive assessment.

Jaw-thrust maneuver. This maneuver opens the airway by displacing the jaw forward without extending the neck, minimizing risk of exacerbating cervical spine injury.

Head tilt–chin lift. This technique lifts the tongue away from the posterior pharynx by tilting the head back and lifting the chin, effectively opening the airway in patients without spinal concerns.

Oropharyngeal airway (OPA). It maintains an open airway by holding the tongue forward in unconscious patients lacking a gag reflex, preventing obstruction without triggering vomiting.

Nasopharyngeal airway (NPA). It provides a patent airway passage through the nose without stimulating the gag reflex, making it suitable for semi-conscious or responsive patients needing support.

Presence of a gag reflex (responsive patient). An intact gag reflex in responsive patients can trigger vomiting or laryngospasm upon OPA insertion, risking aspiration or further airway compromise.

Suspected basilar skull fracture. Insertion risks penetrating the cribriform plate and entering the cranial cavity, potentially causing severe complications like meningitis or brain injury.

Corner of mouth to earlobe (angle of jaw). This measurement ensures the OPA fits properly from the lips to the pharynx, preventing inadequate airway opening or trauma from improper sizing.

Tip of nose to earlobe (angle of jaw). This measurement approximates the distance from nostril to nasopharynx, ensuring the NPA is long enough to bypass the tongue without causing trauma.

Insert upside down, rotate $180^\circ$ as it advances. Rotating after initial insertion aligns the curved tip with the pharyngeal anatomy, facilitating smooth placement without traumatizing tissues.

Water-soluble lubricant. It facilitates smooth insertion through the nasal passage without causing mucosal irritation or damage, unlike petroleum-based products that can degrade materials.

Suction the airway. Suctioning directly removes visible fluids or debris, restoring airway patency more effectively than positioning or adjuncts alone.

No more than $15$ seconds per attempt. Limiting duration prevents hypoxia from prolonged oxygen deprivation during suctioning, balancing clearance with maintaining ventilation.

No more than $10$ seconds per attempt. Shorter suction times reduce the risk of hypoxia in children, who have smaller oxygen reserves and higher metabolic rates.

No more than $5$ seconds per attempt. Infants have minimal oxygen reserves, so brief suctioning minimizes hypoxia while allowing quick resumption of ventilation.

Nonrebreather mask at $10$–$15$ L/min. It delivers high FiO2 (up to 90-100%) to correct severe desaturation, with a reservoir bag ensuring consistent oxygen supply during inhalation.

Bag-valve mask (BVM) with high-flow oxygen. BVM allows manual positive-pressure ventilation with supplemental oxygen, ensuring adequate tidal volume and rate for patients unable to breathe independently.