NREMT Emergency Medical Technician (EMT) Cognitive ExamAirway, Respiration & VentilationEasy
A 38-year-old male is found unresponsive with shallow, gurgling respirations at a rate of 6 breaths per minute. His pulse is 50 bpm and strong. Which of the following is the most appropriate initial intervention?
- AApply a non-rebreather mask at 15 L/min.
- BPerform a head-tilt, chin-lift maneuver and reassess breathing.
- CInsert an oropharyngeal airway and begin positive pressure ventilation.
- DAdminister an albuterol nebulizer treatment.
Show answer & explanationAnswer & explanation
Correct answer: C. Insert an oropharyngeal airway and begin positive pressure ventilation.
The patient has shallow, gurgling respirations and a very low respiratory rate, indicating inadequate breathing and a likely airway obstruction from the tongue or secretions. Positive pressure ventilation is needed, and an OPA will help maintain an open airway.
Why the other options are wrong
- A. A patient with inadequate breathing needs assisted ventilation, not just supplemental oxygen via a non-rebreather mask.
- B. While a head-tilt, chin-lift is a good initial step, the patient's respiratory rate is too low for simple repositioning to be sufficient. He requires assisted ventilation.
- D. There is no indication of bronchospasm or asthma, and an albuterol nebulizer would not address the immediate life threat of inadequate breathing.
Inadequate Breathing Intervention
For patients with inadequate breathing (too slow, too shallow, or absent), the primary intervention is to open the airway and provide positive pressure ventilation.
- Signs of inadequate breathing include respiratory rates below 8 or above 28, shallow chest rise, diminished or absent breath sounds, and cyanosis.
- Gurgling indicates fluid or secretions in the airway, often from the tongue falling back.
- Positive pressure ventilation (e.g., BVM) is critical to ensure adequate oxygenation and ventilation.
Memory trick: Open, Ventilate, and Oxygenate; don't wait for it to be too late.