Airway, Respiration, and Ventilation
What this domain tests
The NREMT separates three ideas candidates often blur: the airway must be open, breathing must move gas, and ventilation must match metabolic demand. Items test device selection, oxygen flow rates, ventilation rates, and recognition of inadequate breathing.
Core rules
- Open the airway first: head-tilt/chin-lift for most patients; jaw-thrust when spinal injury is suspected.
- Oropharyngeal airways suit unresponsive patients with no gag reflex. Nasopharyngeal airways suit patients with a gag but are avoided with severe midface trauma or suspected basilar skull fracture.
- Suction no longer than 15 seconds in an adult, 10 in a child, 5 in an infant, and preoxygenate before and after.
- Nasal cannula 1–6 L/min (roughly 24–44%); simple mask 6–10 L/min; nonrebreather 10–15 L/min with reservoir; BVM at 15 L/min delivers close to 100%.
- BVM with a pulse: adult one breath every 5–6 seconds; child or infant one every 3–5 seconds. In cardiac arrest with an advanced airway, one breath every 6 seconds.
- Normal capnography is 35–45 mmHg. A sudden fall or loss of waveform suggests tube displacement, obstruction, or circulatory collapse.
Worked example
A 62-year-old is unresponsive, breathing 6/min with snoring. You open the airway, insert an OPA, and ventilate with a BVM at 15 L/min, one breath every 5 seconds, confirming chest rise and watching EtCO2. Snoring plus a slow rate means inadequate ventilation, not merely low oxygen.
Traps
High-flow oxygen does not correct hypoventilation; bagging too fast lowers EtCO2 and cerebral perfusion; a patient who can speak is not automatically ventilating adequately; and an OPA in a patient with a gag reflex causes gagging, vomiting, and aspiration risk.