Airway

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Infant airway positioning

An infant's airway is smaller and more anterior than an adult's, so slight head extension or flexion can kink the passage and obstruct airflow. For a medical patient without suspected spinal injury, your goal is a straight, open path from nose and mouth to lungs—not a forced tilt backward or chin-on-chest flexion.

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COPD exacerbation and CPAP

Chronic obstructive pulmonary disease flares show up as increased work of breathing—prolonged exhalation, pursed-lip breathing, accessory muscle use—often with hypoxia on pulse oximetry. EMTs do not withhold oxygen in difficulty breathing because of COPD history; treat the patient in front of you and follow protocol.

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Bag-valve-mask tidal volume

Ventilation is a balance: enough volume to produce visible chest rise, not so much that you pressurize the chest. Each breath should move the chest without forcing the stomach to distend.

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Recognizing respiratory failure

Respiratory distress means the patient is working harder to breathe but still moving an adequate rate and tidal volume. Retractions, stridor, dyspnea, and anxiety signal distress—they do not by themselves define failure.

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Treating respiratory failure

Labored respirations with peripheral cyanosis and altered mental status are failure until proven otherwise. Airway and breathing interventions precede gathering secondary vital signs—a pulse rate can wait when oxygenation is failing.

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Snoring respirations and the gag reflex

Snoring in an unconscious patient usually means the tongue is obstructing the pharynx. You need a basic airway adjunct before effective bag-valve-mask ventilations—not suction first when there is no fluid and not an oropharyngeal airway when the patient still gags.

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Inhalation injury and stridor

Thermal or chemical injury to the upper airway can swell quickly. Facial burns, soot, and audible stridor warn that obstruction may be minutes away even when the patient is still talking.

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Suction for gurgling respirations

Gurgling means fluid or secretions in the upper airway. Ventilating through that noise pushes material deeper and wastes time—clear what you can hear before you seal a mask or listen to lung sounds.

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When the patient gags on an OPA

Gagging after oropharyngeal airway placement means the patient's airway defenses are active—forcing the device invites vomiting and aspiration. Never hold an OPA in place against a gag.

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Distress, failure, and arrest

Examiners love contrast questions: accessory muscle use with adequate rate and tidal volume defines respiratory distress, not failure, arrest, or apnea.

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Gastric distention during BVM

When the abdomen balloons during bag-valve-mask ventilation, air is going into the stomach instead of the lungs. High airway pressure forces the esophagus open; bigger tidal volume or higher oxygen concentration will not fix that path.

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Apnea after high-mechanism trauma

A fall from height with apnea is a trauma airway problem and a spine problem at the same time. Moving the head before someone holds the neck can worsen an unstable cervical injury.

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When BVM ventilation gets harder

Rising resistance during bag-valve-mask ventilation usually means the airway path has slipped—head position drifted, the mask seal leaked, or the adjunct shifted—not that the patient suddenly needs more oxygen flow.

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Who gets a non-rebreather mask

A non-rebreather mask delivers high-concentration oxygen only when the patient can still move adequate tidal volume on their own. Inadequate rate or shallow breathing needs bag-valve-mask support, not a mask that waits for the patient to inhale.

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Ventilating agonal breathing

Agonal breaths are ineffective gasps—rate and often volume are already inadequate. Matching those gasps or “assisting” them leaves the patient hypoventilated.

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Partial foreign-body obstruction

A standing adult who is choking but still moving air with stridor has a partial obstruction. Forceful interventions can convert that into a complete block.

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Smoke inhalation with shallow breathing

After a house fire, a hoarse voice warns of airway burn and swelling, but rapid shallow respirations mean the patient is already failing to move enough air. High-flow oxygen by non-rebreather cannot replace lost tidal volume.

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Recognizing acute pulmonary edema

Waking up feeling smothered when lying flat (orthopnea) plus bilateral basilar rales (crackles) points strongly to fluid in the alveoli—acute pulmonary edema—often from left-sided heart failure.

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CPAP for cardiogenic pulmonary edema

An alert patient with crackles, clammy skin, and cyanosis from left-sided heart failure is drowning in alveolar fluid. A metered-dose inhaler treats bronchospasm, not hydrostatic edema; a non-rebreather alone does not push fluid out of the alveoli.

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Overventilation in asthma failure

Asthmatic airways empty slowly. Stacking bag-valve-mask breaths before exhalation finishes traps air, inflates the chest, and raises intrathoracic pressure.

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