Chapter 11: Airway Management

Tongue

The most common cause of airway obstruction in the unconscious patient.

Oropharyngeal Airway (OPA)

Used in unresponsive patients without a gag reflex to keep the tongue from blocking the airway.

OPA Contraindications

Conscious or semi-conscious patient; presence of gag reflex.

Nasopharyngeal Airway (NPA)

Used in semi-conscious patients with an intact gag reflex.

NPA Contraindications

Severe head injury with blood in the nose; suspected skull fracture.

Recovery Position

Left lateral position for uninjured unconscious patients to maintain airway.

Hypoxia

Low oxygen saturation (SpO₂ < 94%); always provide oxygen if suspected.

Oxygen Cylinder Pressure

Typically 2,000–2,200 psi when full.

Pin Indexing System

Prevents attaching the wrong regulator to a gas cylinder.

Oxygen Regulator

Reduces cylinder pressure to 40–70 psi and controls oxygen flow rate.

Combustion Hazard

Oxygen supports combustion but is not flammable.

Oxygen Toxicity

Too much oxygen can harm patients, especially those with COPD.

Target SpO₂

Maintain 94–99% for most; 88–92% for COPD patients.

Nonrebreather Mask (NRB)

Delivers 10–15 L/min (~90% O₂) for adequate breathing with hypoxia.

Nasal Cannula

Delivers 1–6 L/min (24–44% O₂) for mild hypoxia.

Partial Rebreather Mask

Allows rebreathing some exhaled air; less used today.

Venturi Mask

Provides precise oxygen concentrations; useful for COPD patients.

Tracheostomy Mask

Delivers oxygen over a stoma or trach opening.

Bag-Valve-Mask (BVM)

Device for positive pressure ventilation in respiratory failure.

Reservoir Bag

Must remain inflated before and during use; collapse = low flow.

Minute Volume

Tidal volume × respiratory rate.

Signs of Inadequate Ventilation

Altered mental status, poor chest rise, cyanosis, accessory muscle use.

Positive Pressure Ventilation

Forces air into lungs; may reduce venous return to heart.

Normal Breathing

Negative pressure draws air naturally into lungs.

Gastric Distension

Air enters stomach during ventilation; may cause vomiting.

Preventing Gastric Distension

Proper airway position, correct rate, appropriate volume.

Passive Ventilation

Air exchange during CPR from chest compressions.

Automatic Transport Ventilator (ATV)

Machine providing controlled ventilations; frees EMT’s hands.

CPAP (Continuous Positive Airway Pressure)

Noninvasive ventilation that keeps alveoli open during respiratory distress.

CPAP Indications

Alert, cooperative, moderate/severe distress, SpO₂ < 90%, CHF/pulmonary edema.

CPAP Contraindications

Respiratory arrest, altered mental status, hypotension, vomiting, trauma, pneumothorax, tracheostomy, GI bleed.

CPAP Pressure

Typically 7–10 cm H₂O; BLS units fixed around 10.

CPAP Complications

Claustrophobia, lung injury, decreased BP, pneumothorax.

Stoma

Permanent surgical opening in the trachea for breathing.

Tracheostomy

Stoma with tube placed; breathing through the neck.

Ventilating Through a Tracheostomy

Attach BVM to trach tube or use pediatric mask over stoma.

Airway Obstruction

Blockage of the airway by tongue, food, or foreign body.

Mild Airway Obstruction

Can breathe/cough; encourage coughing, monitor.

Severe Airway Obstruction

No air movement, silent cough, cyanosis; perform Heimlich.

Universal Choking Sign

Hands around throat indicating airway obstruction.

Unresponsive Choking Patient

Begin CPR; check mouth before ventilations.

Finger Sweep

Only remove visible object; never perform blind sweep.

Dentures

Remove if loose/broken; leave secure dentures in place.

Facial Bleeding

Can obstruct airway; suction and control bleeding.

EMT Role in Advanced Airway

Assist with BVM, suction, jaw thrust, confirming tube placement.

BVM Ventilation Rate

Adult: 1 breath every 5–6 sec; Pediatric: 1 every 2–3 sec.

NRB Flow Rate

10–15 L/min (high-flow oxygen).

Nasal Cannula Flow Rate

1–6 L/min (low-flow oxygen).

O₂ Cylinder Safety

Secure, store sideways, handle carefully, never stand unattended.

COPD Oxygen Range

Maintain SpO₂ between 88–92%.

aerobic metabolism Metabolism that can proceed only in the presence of oxygen.

agonal gasps Occasional, gasping breaths that occur after the heart has stopped.

airway The upper airway tract or the passage above the larynx, including the nose, mouth, and throat.

alveolar minute volume Volume of air moved through the lungs in one minute minus dead space; tidal volume (minus dead space) × respiratory rate.

alveolar ventilation Volume of air that reaches the alveoli; tidal volume minus dead space air.

American Standard Safety System Safety system for large oxygen cylinders to prevent regulator misattachment.

anaerobic metabolism Metabolism in the absence of oxygen; produces lactic acid.

apnea Absence of spontaneous breathing.

aspiration Introduction of vomitus or other foreign material into the lungs.

ataxic respirations Irregular, ineffective respirations with no consistent pattern.

automatic transport ventilator (ATV) Ventilation device with adjustable settings; frees EMT for other tasks.

bag-valve mask (BVM) Handheld device with mask and one-way valve; delivers >90% oxygen when used with reservoir and O₂.

barrier device Protective mask or valve device that limits exposure to body fluids.

bilateral Condition or structure present on both sides of the body.

bronchioles Smallest subdivisions of bronchi; smooth muscle that dilates or constricts.

capnography Noninvasive method measuring CO₂ concentration in exhaled air over time.

capnometry Use of a device (capnometer) that measures the amount of exhaled CO₂.

carina Point where trachea divides into left and right bronchi.

chemoreceptors Monitor O₂, CO₂, and pH levels; send feedback to control breathing rate and depth.

compliance Ability of alveoli to expand when air is drawn in.

continuous positive airway pressure (CPAP) Noninvasive ventilation for patients in respiratory distress; can prevent intubation.

dead space Portion of tidal volume not reaching alveoli; does not participate in gas exchange.

diffusion Movement of molecules from high to low concentration.

dyspnea Shortness of breath.

end-tidal CO₂ Amount of CO₂ present at the end of exhalation.

exhalation Passive process where diaphragm/intercostals relax, forcing air out.

external respiration Gas exchange between lungs and blood (pulmonary respiration).

gag reflex Reflex that causes retching; triggered by touching soft palate or throat.

gastric distention Air filling the stomach, often from excessive ventilation pressure or volume.

glottis Space between vocal cords; narrowest part of adult airway.

good air exchange Mild obstruction; patient conscious and able to cough forcefully.

head tilt-chin lift maneuver Airway opening technique (non-trauma patients).

hypercarbia Increased CO₂ level in blood.

hypoxia Condition where tissues and cells lack sufficient oxygen.

hypoxic drive Respiratory stimulus triggered by low O₂ (seen in chronic lung disease).

inhalation Active process drawing air into lungs.

internal respiration Gas exchange between blood and tissue cells.

intrapulmonary shunting Blood bypassing nonfunctional alveoli to left heart.

jaw-thrust maneuver Airway opening for suspected spinal injury.

labored breathing Breathing requiring increased effort; often uses accessory muscles.

larynx “Voice box”; marks division between upper and lower airway.

manually triggered ventilation device O₂-powered device delivering breaths when button pressed.

mediastinum Chest cavity area containing heart, major vessels, trachea, and esophagus.

metabolism (cellular respiration) Chemical process producing energy from nutrients in cells.

mild airway obstruction Partial blockage; adequate airflow but with distress.

minute volume Air moved in one minute (tidal volume × respiratory rate).

nasal cannula Device delivering 24–44% O₂ via prongs in nostrils.

nasopharynx Nasal cavity; filters and protects respiratory tract.

nonrebreathing mask Mask with reservoir; delivers up to 90% O₂; prevents rebreathing CO₂.

oropharyngeal (oral) airway Adjunct to keep tongue from blocking airway in unresponsive patient.