Airway management begins with selecting the appropriate manual maneuver based on suspected spinal injury. In patients without suspected spine injury, the head-tilt chin-lift opens the airway by lifting the tongue away from the posterior pharynx. When spinal injury is possible, the jaw-thrust maneuver is used instead, as it opens the airway without extending the neck. Adjuncts such as the oropharyngeal airway (OPA) are inserted in unresponsive patients without a gag reflex, sized from the corner of the mouth to the earlobe or angle of the jaw. The nasopharyngeal airway (NPA) is preferred for responsive patients or those who cannot tolerate an OPA, sized from the tip of the nose to the earlobe, but is contraindicated in suspected basilar skull fracture or severe facial trauma.
Effective breathing assessment looks for signs of both adequate and inadequate respiration. Adequate breathing includes normal rate and rhythm, equal chest rise, adequate depth, normal skin color, and no accessory muscle use. Inadequate breathing may present as a rate that is too fast or slow, shallow depth, irregular rhythm, cyanosis, accessory muscle use, and altered mental status. Agonal breathing, an ineffective gasping pattern, is not adequate breathing and requires immediate ventilatory support, typically with a bag-valve-mask (BVM), which is the device of choice for ventilating a non-breathing patient with a pulse. Oxygen delivery devices are selected by patient need: a nasal cannula at 1–6 liters per minute delivers roughly 24–44% oxygen, while a nonrebreather mask at 10–15 liters per minute can provide up to approximately 90% oxygen. Capillary refill of less than 2 seconds and pulse oximetry of 95–100% are useful adjuncts; in patients with darker skin, mucous membranes, nail beds, palms, and soles are preferred assessment sites.
Cardiopulmonary resuscitation follows age-specific protocols. For adult CPR with one rescuer, the compression-to-ventilation ratio is 30:2 at a rate of 100–120 compressions per minute and a depth of at least 2 inches (5 cm), not exceeding 2.4 inches (6 cm). For two-rescuer infant or child CPR, the ratio changes to 15:2, with infant compressions about 1.5 inches (4 cm) deep and child compressions about 2 inches (5 cm). Pulse checks are performed at the carotid artery in unresponsive adults and at the brachial artery in infants. Once an advanced airway is in place, ventilation becomes asynchronous with compressions at one breath every 6 seconds (10 breaths per minute). An automated external defibrillator (AED) is used to analyze rhythm and shock lethal arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia; the EMT must ensure no one is touching the patient before delivering a shock. Airway obstruction is managed with abdominal thrusts (Heimlich maneuver) in conscious adults, while conscious infants receive alternating 5 back blows and 5 chest thrusts.