Airway, Respiration & Ventilation makes up roughly 18 to 22 percent of the NREMT cognitive exam — about one in five questions. The category is heavily weighted because airway compromise is the fastest way for a patient to die, and the NREMT wants verification that you can recognize and intervene quickly.
This guide covers the topics tested most often, the doses and rates worth memorizing, and several sample questions in NREMT format with full rationales.
What's tested in this category
- Recognition of adequate vs inadequate breathing (rate, depth, effort).
- Selection of appropriate oxygen delivery device based on patient presentation.
- Bag-valve-mask (BVM) ventilation technique and rates.
- Use of basic airway adjuncts — OPA and NPA — including indications, contraindications, and sizing.
- Suctioning technique and time limits by age.
- Advanced airway adjuncts within the EMT scope (BIAD use varies by state and protocol).
- Recognition and management of upper airway obstruction.
- Pediatric and geriatric airway considerations.
Numbers worth memorizing cold
- Adult adequate respiratory rate: 12–20/min. Outside this range = inadequate breathing.
- Pediatric rate: varies by age — infants 30–60, toddlers 24–40, school-age 20–30.
- Nasal cannula: 1–6 LPM, FiO₂ ~24–44%.
- Non-rebreather: 10–15 LPM, FiO₂ ~85–90%.
- BVM with reservoir: 15 LPM, FiO₂ near 100%.
- BVM ventilation rate (adult with pulse): 1 breath every 5–6 seconds (10–12/min).
- BVM ventilation rate (pediatric with pulse): 1 breath every 2–3 seconds.
- Suction time limits: adult ≤15 seconds, child ≤10, infant ≤5.
Not sure how much of this you actually know? Ten questions gives you a readiness score in about three minutes.
Take the free quizOPA vs NPA — when to use which
- OPA — for unconscious patients without a gag reflex. Sized from corner of mouth to angle of jaw or earlobe.
- NPA — for conscious or semi-conscious patients who tolerate it. Contraindicated in suspected basilar skull fracture or significant facial trauma. Sized from nostril to earlobe.
- If a patient gags on an OPA, remove it. The OPA is contraindicated whenever a gag reflex is present.
Sample airway question
Your turn — pick an answer
You are managing a 28-year-old male in cardiac arrest. CPR is in progress and your partner is preparing to ventilate with a bag-valve-mask. What is the correct ventilation strategy during CPR?
Rationale
Without an advanced airway in place, the correct CPR ratio is 30:2 — pause compressions briefly, deliver 2 breaths over about 1 second each, and resume compressions immediately. Continuous compressions with asynchronous ventilation only applies once an advanced airway (supraglottic or endotracheal) is in place. Hyperventilation worsens outcomes by increasing intrathoracic pressure and reducing venous return.
Sample respiratory distress question
Your turn — pick an answer
A 67-year-old female with a history of COPD is in respiratory distress. She is awake, alert, and using accessory muscles. SpO₂ is 86% on room air. Which of the following is the MOST appropriate initial oxygen delivery device?
Rationale
An SpO₂ of 86% with respiratory distress requires high-flow oxygen via non-rebreather. The hypoxic drive concern is real but should never delay oxygen for a hypoxic COPD patient — treat the hypoxia, monitor for changes in mental status, and titrate down once SpO₂ improves. BVM is for inadequate ventilation, not respiratory distress with adequate spontaneous breathing. Nasal cannula at 2 LPM is inadequate for this hypoxia level.
Common airway exam mistakes
- Confusing respiratory distress (work of breathing problem, treat with oxygen) with respiratory failure (ventilation problem, treat with BVM).
- Withholding oxygen from a hypoxic COPD patient because of theoretical hypoxic drive concern.
- Hyperventilating during BVM use — fast rates worsen outcomes.
- Choosing nasal cannula for a critical patient because it's 'less invasive' — pick the device that matches the need.
- Forgetting that an OPA must be removed if a gag reflex returns.
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