Airway Management, Ventilation, and Oxygenation
The Kuwait MOH paramedic exam tests airway decisions under time pressure: recognizing obstruction, choosing the least invasive effective airway, and confirming ventilation with waveform capnography. Oxygen is a drug and must be titrated.
Core rules
- Assess patency by look, listen, and feel. In an unresponsive patient use head-tilt/chin-lift unless trauma is suspected, then use jaw thrust.
- Suction blood or vomit before inserting adjuncts. An OPA is only for patients without a gag reflex; an NPA is avoided with signs of basilar skull fracture.
- BVM ventilation with 15 L/min oxygen and a two-person technique is preferred. Squeeze over 1 second, just enough for chest rise, and avoid hyperventilation.
- Confirm every advanced airway with continuous waveform capnography plus clinical assessment. A flat waveform suggests esophageal placement or dislodgement.
- Target SpO2 94–98% for most adults, 88–92% in COPD patients at risk of hypercapnia, and 100% during cardiac arrest and anaphylaxis.
Worked example
A 42-year-old trauma patient is unresponsive with snoring respirations, SpO2 88%, and a suspected facial injury. You suction, perform jaw thrust, insert an NPA, and ventilate by BVM. SpO2 rises to 97% and capnography shows a normal waveform. You do not intubate immediately because the airway is patent and ventilation is effective; you prepare for transport and reassess.
Traps
Using an OPA in a patient with a gag reflex; trusting auscultation alone for tube placement; giving high-flow oxygen to every COPD patient; forgetting to suction before adjunct insertion; and hyperventilating during CPR.