Airway, Respiration, and Ventilation
The three questions
Every respiratory call comes down to three separate questions: is the airway open, is the patient breathing adequately, and is ventilation effective? Airway is anatomy, breathing is gas exchange, and ventilation is moving air. A patient can have an open airway and still be ventilating poorly.
Opening the airway
Use head-tilt/chin-lift for a medical patient with no suspected spinal injury; use a jaw-thrust with manual spine motion restriction when trauma is suspected. Suction visible fluid, blood, or vomit-no more than about 10 seconds at a time in an adult, less in a child-then reoxygenate.
Adjuncts and oxygen
An oropharyngeal airway (OPA) is only for an unresponsive patient with no gag reflex; measure from the corner of the mouth to the earlobe. A nasopharyngeal airway (NPA) can be used in a patient with a gag reflex, but avoid it with severe facial trauma or suspected basilar skull injury. Give oxygen by nasal cannula (1–6 L/min) for mild needs, a nonrebreather (10–15 L/min) for serious illness, and ventilate with a bag-valve-mask when breathing is inadequate. A BVM works best with two rescuers and a good seal.
Traps
Do not assume a patient who is breathing is oxygenating well-look at rate, depth, effort, skin color, and mental status. Agonal gasps are not adequate breathing. Pulse oximetry reads saturation, not ventilation, and is unreliable with poor perfusion, cold extremities, or nail polish.
Rule of thumb
If the patient is unresponsive and not breathing adequately, open the airway, suction if needed, insert an adjunct, and ventilate at the correct rate-about one breath every 5–6 seconds for an adult-while arranging transport.