Airway and Ventilation Prep
for EMTs

Lesson 2 of 7 · about 7 min

Opening and keeping an airway

Positioning, head-tilt chin-lift and jaw thrust, oral and nasal airways, suction

An open airway is the first treatment, and most of the time it costs nothing but your hands. Adjuncts and suction keep open what positioning opened. None of them replaces watching the patient.

Position first

A patient who is awake and working to breathe has usually found the best position already: upright, often leaning forward. Do not lay that patient down. An unresponsive patient who is breathing well and has no suspected spinal injury can go in the recovery position, on the side, so the tongue falls forward and fluid drains out of the mouth. An unresponsive patient who needs airway work goes on the back.

The two manual maneuvers

Head-tilt chin-lift is for the patient with no suspected spinal injury. One hand on the forehead tilts the head back while the fingertips of the other lift the bony part of the chin. Jaw thrust is for the patient who may have a spinal injury. From above the head, place your fingers behind the angles of the lower jaw and lift it forward without tilting the head. If a jaw thrust does not open the airway and the patient is not moving air, the airway wins: add the smallest head tilt that works.

Adjuncts hold the tongue

An oral airway is only for a patient with no gag reflex. Measure from the corner of the mouth to the angle of the jaw. Too small can still let the tongue block the airway, and too large can trigger a spasm that closes it. In an adult, insert it upside down or sideways and rotate it into place. In a child or infant, hold the tongue down with a tongue depressor and insert it right side up so you do not injure the palate. If the patient gags, take it out and be ready to suction.

A nasal airway is tolerated by patients who still have a gag reflex, such as the semi-responsive overdose patient or the patient with clenched teeth after a seizure. Measure from the tip of the nose to the earlobe, coat it with a water-based lubricant, and slide it along the floor of the nostril with the concave side facing down. Never force it; gently rotate it if you feel resistance. Avoid it with significant facial trauma or signs of a skull base fracture; the tube can pass into the skull.

Suction

Gurgling means fluid, and fluid means suction before anything else. You cannot ventilate through vomit; you only push it toward the lungs.

1. Turn the suction on and test it before it goes in the mouth.
2. Use a rigid, Yankauer-style tip for the mouth.
3. Insert without suction, then apply suction as you withdraw, moving the tip side to side.
4. Limit each pass to about 15 seconds in an adult and 10 seconds in a child or infant, because suction removes oxygen along with fluid.
5. Give oxygen or ventilate between passes.

If the mouth keeps filling faster than you can clear it, log roll the patient onto the side, keeping the spine in line if injury is suspected, and clear the mouth from there. A soft catheter is for the nose, for infants, and for a stoma. Watch the heart rate in infants and children: a slowing pulse during suction means stop and oxygenate.