EMT-Basic Exam: The Basics of Airway - Opening the Airway

Once you’ve established that the patient is suffering from inadequate breathing, you should ensure that the patient’s airway remains open. A blocked or closed airway can lead to death. In the following section, you’ll review the different ways to open the airway in an emergency situation.

Tip: In an emergency situation, it’s up to the EMT-Basic to ensure that the patient’s airway remains open and clear.

1. Manual Positioning
Whether a patient is conscious or unconscious, the first thing you should do is get him or her into the supine position (lying on his or her back and facing up).

Unconscious patients sometimes lose control of their jaw, which may cause the tongue to fall to the back of their throat. This can cause the epiglottis to block the glottic opening and close the airway. In situations where there is no suspected trauma, use the head-tilt chin-lift technique to open the airway. This technique helps pull the tongue out of the oropharynx and moves the epiglottis away from the glottis. Remember, you should use two fingers to slowly tilt the head back and lift the chin when performing the head-tilt chin-lift technique.
If you suspect the patient has suffered trauma, you should avoid moving the neck, which could damage the spinal cord. Instead, perform the jaw thrust maneuver. This technique is used to move the jaw forward, which opens the airway. To perform this technique, carefully push the jaw forward using your thumbs, keeping your index fingers near the mouth opening.
After the airway is opened, check the patient for signs of breathing by listening for breath sounds and feeling the patient’s chest for movement. If the patient is unable to maintain regular breathing, you should use an airway adjunct to keep the airway open.

2. Airway Adjuncts
An airway adjunct is a device that helps keep the airway open. There are two types of airway adjuncts: oropharyngeal airways and nasopharyngeal airways. The oropharyngeal airway is inserted into the mouth, while the nasopharyngeal airway is inserted into the nose.


The oropharyngeal (left) and nasopharyngeal (right) airways.

a. Oropharyngeal Airway
The oropharyngeal airway is a curved piece of plastic that is inserted into the patient’s mouth. This device lifts the tongue out of the oropharynx. Also called the oral airway or OP airway, the oropharyngeal airway comes in a range of sizes. The oropharyngeal airway is usually used on unresponsive patients who have no gag reflex. The gag reflex causes a person to gag when something stimulates the back of the throat, preventing foreign materials from getting caught in the airway. You should not use this type of airway adjunct on a patient who has a gag reflex because the position of the device could cause the patient to vomit or gag. Remember to review the different ways to insert an oropharyngeal airway on adults, children, and infants.

b. Nasopharyngeal Airway
The nasopharyngeal airway, also called the nasal airway or NP airway, is made of flexible rubber or plastic that is inserted into the patient’s nostril to provide an airway. Like the oropharyngeal airway, the nasopharyngeal airway comes in a range of sizes. This device is usually used on responsive patients who need help maintaining a clear airway. This airway is a good choice for responsive patients who need assistance breathing because it doesn’t stimulate the gag reflex. You can use the same technique to insert the nasopharyngeal airway on adults, children, or infants. Remember to choose the correct size and use lubrication because insertion of the nasopharyngeal airway can be painful to a responsive patient.

3. Suctioning Techniques
After an airway is established, it can sometimes become blocked by liquids such as blood, mucus, or saliva; small particles of vomit; broken teeth; or food. If this happens, you must clear the airway. Any material inhaled into the lungs can cause damage to lung tissue, so it’s important to monitor the patient carefully to avoid this.

Tip: If you hear a gurgling sound coming from the patient, this could be a sign that the airway is blocked.
You can clear the airway by rolling the patient onto his or her side and allowing fluids to drain from the mouth. Sometimes you may need to use suction to remove fluids and small particles from the airway.

a. Suction Units
Suction units are important when treating patients with obstructed airways. EMT-Basics should be familiar with three types of suction units: mounted, portable, and hand-operated devices. Most ambulances have mounted, or built-in, suction units powered by the vehicle’s battery, portable suction units powered by batteries, and hand-operated suction units. These different suction units can either be used on scene or while transporting patients.
Suction units work by using a vacuum pump to suction, or suck, materials out of the patient’s airway and into a canister. They are used in conjunction with a suction catheter, which is attached to the end of the tubing before it’s placed into the patient’s mouth.
The suction catheters used by EMT-Basics are either rigid or soft. Rigid catheters (also called hard, tonsil tip, tonsil sucker, or Yankauer catheters) are made of hard plastic and are easy to control. They’re usually used on unresponsive patients. Rigid catheters can be used on patients of any age. With children and infants, however, it is important to avoid hitting the back of the throat because stimulation of this area can decrease the heart rate.
Soft catheters, also called French catheters, are made of long, flexible plastic and used to suction nasal passages. They are often used in situations where rigid catheters cannot be used, such as when the patient is responsive. A bulb syringe may be used in conjunction with a soft catheter for infants and children under 6 months of age. It’s important to remember that you should never insert any catheter farther than the base of the tongue.
Before taking the EMT-Basic exam, be sure to review the proper techniques for using different types of suction units and catheters.

Tip: Oxygen is removed during suctioning, so you must limit suctioning to 10–15 seconds and administer oxygen before and after suctioning.

Related Topics You Should Review:
- Insertion of an oropharyngeal airway; noting the differences between adults, children, and infants
- Insertion of a nasopharyngeal airway
- Using suctioning units
- Proper suctioning techniques
- Using a soft catheter and bulb syringe to suction an infant’s airway