EMT-Basic Exam: The Basics of Airway - Artificial Ventilation

You’ve already learned about the different techniques that maintain and clear the airway. However, sometimes patients with cleared airways still have trouble breathing on their own and must be artificially ventilated. In this guide, you’ll review the different techniques of artificial ventilation, which include the following:
- Mouth-to-mouth
- Mouth-to-mask
- Bag-valve mask (BVM)
- Flow-restricted, oxygen-powered ventilation
You’ll also learn about the different ways to administer oxygen to patients who have difficulty breathing on their own.

1. Mouth-to-Mouth
Although you probably learned about mouth-to-mouth, or rescue breathing, ventilation as part of your CPR training, take a few moments to review the basics. This technique is performed by placing your mouth over the patient’s mouth to deliver oxygen to the patient. After you’ve ensured that the patient’s airway is open, take a deep breath and pinch the patient’s nose shut. Place your mouth over the patient’s mouth, ensuring you have an airtight seal. Exhale just enough to make the patient’s chest rise. Continue mouth-to-mouth ventilation at a rate of 1 breath every 5 seconds for an adult and 1 breath every 3–5 seconds for a child. For infants, place your mouth over the infant’s nose and mouth, delivering 1 breath every 3 seconds.
Because of the direct physical contact that mouth-to-mouth ventilation requires, this technique is no longer one of the preferred artificial-ventilation methods used by EMT-Basics. However, all trainees are required to learn this method.

2. Mouth-to-Mask
Mouth-to-mask ventilation uses the same principle as mouth-to-mouth ventilation to deliver oxygen to a patient, but requires the use of a mask, such as a portable pocket mask. This mask can be used with or without supplemental oxygen. Pocket masks can be used on adults, children, and infants. They come in a variety of sizes, so it is important to choose the appropriate size for your patient. After clearing the airway and inserting either an oropharyngeal or a nasopharyngeal airway adjunct, place a mask over the patient’s nose and mouth. (Oxygen could be connected to the mask at this point.) Seal the mask over the patient’s face and place your mouth on the mask’s valve. Exhale into the valve just enough to make the patient’s chest rise. Continue at the same rate used for mouth-to-mouth ventilation.

3. Bag-Valve Mask (BVM)
The bag-valve mask (BVM) is a ventilation device that consists of a self-inflating bag, a one-way valve, a mask, and an oxygen reservoir. After clearing the airway and inserting either an oropharyngeal or a nasopharyngeal airway adjunct, connect the oxygen to the mask and place it over the patient’s nose and mouth. Next, squeeze the bag to ventilate the patient. The one-way valve prevents the patient from rebreathing exhaled air. A BVM comes in different sizes and can be used on adults, children, and infants. Although it’s possible for one EMT-Basic to provide adequate ventilation using a BVM, the technique is more effective when two EMT-Basics are present.

Bag-valve mask.

a. One-Person Bag-Valve Mask (BVM) Technique
Using a bag-valve mask (BVM) to ventilate a patient is no easy task. It’s difficult for one person to keep the patient’s airway open while also maintaining a proper seal and squeezing the bag. After clearing the airway and inserting either an oral or a nasal airway adjunct, attach the oxygen to the BVM, and then seal the mask over the patient’s nose and mouth using your thumb and index finger. Maintain the patient’s airway by keeping your middle, ring, and little fingers of the same hand under the jaw to gently lift the patient’s chin. Squeeze the bag with your other hand to ventilate the patient. Adults should be ventilated once every 5 seconds and children and infants once every 3–5 seconds. Because this ventilation technique is difficult for one person to perform, it should only be used as a last resort if only one EMT-Basic is present.

b. Two-Person Bag-Valve Mask (BVM) Technique
Using the two-person bag-valve mask (BVM) technique to ventilate a patient is more effective than using the one-person BVM technique. After one EMT-Basic clears the airway and inserts either an oral or a nasal airway adjunct, the second EMT-Basic attaches the oxygen to the BVM and seals the mask over the patient’s nose and mouth. The first EMT-Basic uses two hands to squeeze the bag to ventilate the patient, while the second EMT-Basic ensures that the patient’s airway is maintained. Adults should be ventilated once every 5 seconds and children and infants once every 3–5 seconds.

c. Bag-Valve Mask-to-Stoma
Sometimes you’ll be required to ventilate patients who have had a laryngectomy, the surgical removal of the larynx or voice box. When the larynx is removed, there is no longer a connection between the mouth and trachea. A new opening is made in the front of the neck called a tracheal stoma. The patient breathes through this new opening. To ventilate a patient with a tracheal stoma, attach the BVM directly to the stoma or place a small mask over the stoma. In some cases, you will need to cover the patient’s mouth and pinch the patient’s nose shut to properly ventilate the patient. You don’t need to maintain the patient’s airway in this situation. If this doesn’t work, cover the tracheal stoma, maintain the patient’s airway, and ventilate through the mouth.

4. Flow-Restricted, Oxygen-Powered Ventilation Device
The flow-restricted, oxygen-powered ventilation device is similar to the bag-valve mask. It operates on the same basic principle, except there is no bag. After clearing the airway and inserting either an oral or a nasal airway adjunct, attach the flow-restricted, oxygen-powered ventilation device to the mask, and then seal it over the patient’s nose and mouth. Maintain the patient’s airway by keeping your fourth and fifth digits (ring and little fingers) of the same hand under the jaw to gently lift the patient’s chin. Depress the button to trigger the device and it will automatically administer oxygen. When you see the patient’s chest rise, stop the device to allow for exhalation. Repeat once every 5 seconds. This device should never be used to ventilate children or infants because it could cause lung or tissue damage.

5. Oxygen
Patients may require oxygen in times of stress. As an EMT-Basic, you should immediately provide oxygen to any patient with inadequate breathing. Oxygen is stored in high-pressure tanks that contain gauges. A full oxygen tank contains approximately 2,000 pounds of pressure per square inch. These tanks could explode if not handled properly.

Tip: Any patient who has difficulty breathing should be administered oxygen.

a. Oxygen Delivery Devices
Oxygen is released from the tanks by a valve. A regulator is attached to the valve to control the flow of oxygen from the tank to the patient. Oxygen is delivered to patients through devices such as nonrebreather masks or nasal cannulas.
A nonrebreather mask delivers a high concentration of oxygen to a patient. The mask comes in different sizes and is attached to a bag that stores oxygen. The mask is placed over the patient’s mouth and nose and the patient breathes in the oxygen from the bag. The bag must be full before the mask is placed on a patient. A nonrebreather mask is the preferred method of administering oxygen.
A nasal cannula delivers a lower concentration of oxygen to a patient. This small piece of tubing attaches to the patient’s nose, administering oxygen directly into the nostrils. A nasal cannula is usually used on patients who require long-term oxygen use or for those who don’t tolerate the nonrebreather mask.

Related Topics You Should Review:
- Ventilating children and infants
- Ventilating patients with facial injuries
- Ventilating patients with dental appliances
- Different sizes of oxygen cylinders
- Operating an oxygen tank