Airway & Breathing

Coach Katie

In emergency care we work the ABCs — and Airway and Breathing come first. A patient can't survive a perfect bandage if they can't move air. Learn to open the airway, clear it, judge whether breathing is adequate, and support it when it isn't.

Open the airway

First: make a path for air

An unresponsive patient's tongue often falls back and blocks the airway. Open it with a manual maneuver:

Head-tilt / chin-lift — the go-to maneuver for a medical patient with no suspected spinal injury.
Jaw-thrust — use when a spinal (trauma) injury is suspected, so you open the airway without moving the neck.

Scene safety & BSI first. Make sure the scene is safe and put on your gloves/PPE before you ever touch the patient.

Clear & protect the airway

Look, suction, position

Once it's open, make sure it's clear. Look inside for blood, vomit, or secretions and suction as needed — keep suctioning brief so you don't rob the patient of oxygen.

For an unresponsive patient who is breathing and has no trauma, the recovery position (rolled onto their side) helps fluids drain and keeps the airway open.

Suspected spine injury? Don't roll them into the recovery position — protect the spine and manage the airway with a jaw-thrust and suction instead.

Airway adjuncts — awareness

OPA and NPA basics

EMTs use basic airway adjuncts per protocol to help keep the airway open:

OPA — oropharyngeal

Only for a patient with NO gag reflex. It would make a responsive patient gag or vomit.

NPA — nasopharyngeal

For a patient who may still have a gag reflex. Avoid with suspected head/face injury.

Reassess. An adjunct never replaces good positioning and suction — keep watching that air is actually moving.

Assess breathing

Is this breathing adequate?

Judge rate, depth, effort, and adequacy — not just "are they breathing," but "are they moving enough air?"

Signs of inadequate breathing / distress:

Rate too fast or too slow; shallow breaths.
Retractions and accessory-muscle use (working hard to breathe).
Cyanosis (blue lips/skin) and altered mental status.
Tripod position; speaking only in 1–2 word sentences.

Oxygen & ventilation

Oxygenate — and ventilate when needed

Give oxygen for hypoxia or respiratory distress. When breathing is inadequate or absent, don't just watch — assist ventilations with a bag-valve-mask (BVM) and high-flow oxygen.

Target adequate oxygenation. Aim for enough — avoid unnecessary hyperoxia (piling on more oxygen than the patient needs).

Inadequate breathing is a BVM job. A slow, shallow, drowsy patient needs you to move air for them — a nasal cannula alone won't fix it.

Coach Katie

Two calls. Pick the response that protects the airway and supports breathing first — before anything else.

Coach Katie

Five questions. 75% to pass, then make your pledge.

First: make a path for air

Look, suction, position

OPA and NPA basics

Is this breathing adequate?

Oxygenate — and ventilate when needed

I commit to…