Chapter 1 of 520% of exam

Airway, Respiration & Ventilation

A patent airway and adequate breathing are the foundation of all EMT care. This chapter covers airway assessment, adjuncts, oxygen delivery, and ventilation support.

Airway Assessment

The EMT must rapidly determine whether an airway is open and whether breathing is adequate. Listen for abnormal sounds and watch the rate, depth, and effort of breathing.

Look, listen, and feel

Assess chest rise, air movement, and effort to judge whether breathing is adequate.

Recognize abnormal sounds

Snoring suggests the tongue, stridor suggests upper airway narrowing, and crackles suggest lower airway fluid.

Normal adult rate is 12 to 20

Rates well above or below this range signal distress and possible need for support.

Watch for signs of distress

Accessory muscle use, nasal flaring, and tripod positioning indicate increased work of breathing.

Opening and Clearing the Airway

Manual maneuvers and suction keep the airway open. The technique chosen depends on whether spinal injury is suspected.

Head-tilt/chin-lift for no trauma

Use for unresponsive medical patients without suspected spinal injury.

Jaw-thrust for suspected spine injury

Opens the airway while keeping the head neutral and in-line.

Suction no more than 15 seconds

Suctioning removes oxygen, so limit each attempt and reoxygenate between attempts.

Recovery position protects the airway

Use for unresponsive, adequately breathing patients without trauma to allow drainage.

Airway Adjuncts

Oropharyngeal and nasopharyngeal airways help keep the tongue from obstructing the airway. Correct sizing and patient selection are essential.

OPA only without a gag reflex

An oral airway triggers gagging or vomiting in patients with an intact gag reflex.

Size the OPA correctly

Measure from the corner of the mouth to the earlobe or angle of the jaw.

NPA for intact gag reflex

A nasal airway is tolerated by semiconscious patients but avoided with suspected basilar skull fracture.

Oxygen Delivery

Oxygen devices are selected by the concentration the patient needs and their tolerance. Flow rate must match the device.

Nasal cannula: 1 to 6 L/min

Delivers roughly 24 to 44 percent oxygen for patients needing low concentrations.

Nonrebreather: 10 to 15 L/min

Keeps the reservoir full and delivers about 80 to 90 percent oxygen.

Never withhold oxygen from the hypoxic

Treat hypoxia even in COPD patients, supporting ventilation if breathing is inadequate.

Ventilation Support

When breathing is inadequate or absent, the EMT provides positive-pressure ventilation. Adequate rate, volume, and technique prevent complications.

Confirm chest rise

Visible, gentle chest rise with each breath confirms effective ventilation.

BVM with reservoir at 15 L/min

Delivers nearly 100 percent oxygen when the reservoir stays full.

Adult rescue breathing every 6 seconds

For an apneic adult with a pulse, deliver about 10 breaths per minute.

Avoid over-ventilation

Ventilating too fast or hard causes gastric distention and reduces circulation.

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Cardiology & Resuscitation

Last updated: July 2026