A BVM that will not move air is a seal problem until proven otherwise.
Before you read
Test yourself first: 5 questions
Question 1 of 5
After you place a supraglottic airway in an unresponsive adult, ventilation produces a loud air leak from the mouth and only minimal chest rise. The capnography waveform is small. What should you do?
Answer: A. A loud leak with poor chest rise means the device is not sealing — wrong depth, wrong size or an under-inflated cuff. Correct those quickly; if adequate ventilation still is not achieved, remove it and return to bag-mask ventilation with adjuncts. Forcing bigger, faster breaths only pushes more air into the stomach, and a leak with a poor waveform is not acceptable ventilation.
Question 2 of 5
What is the main advantage of two-rescuer bag-valve-mask ventilation over one-rescuer technique?
Answer: A. The weak point of bag-mask ventilation is almost always the mask seal. With two rescuers, one uses both hands to lift the jaw into the mask and seal it while the other squeezes the bag, which delivers far more reliable volumes. A faster rate is not a goal — over-ventilation is harmful — and an airway adjunct is still needed.
Question 3 of 5
An intubated patient with a severe head injury shows no signs of herniation. What end-tidal CO2 should guide your ventilation?
Answer: A. Normal ventilation protects the injured brain. Routine hyperventilation lowers CO2, constricts cerebral vessels and reduces blood flow to tissue that is already ischemic, so it is reserved for signs of herniation per protocol. High CO2 dilates vessels and raises intracranial pressure, and a perfect saturation does not tell you the CO2 level.
Question 4 of 5
Why is hyperventilating a head-injured patient through a bag-valve device harmful when there are no signs of brain herniation?
Answer: A. Blowing off carbon dioxide causes cerebral vasoconstriction, so the injured brain receives less blood and more secondary injury follows; normal ventilation with end-tidal CO2 in the normal range is the goal. Rising CO2 is the effect of hypoventilation, not hyperventilation, and the harm is not from oxygen or from a direct slowing of the heart.
Question 5 of 5
After prolonged bag-mask ventilation, an intubated 2-year-old has a tense, distended abdomen and is increasingly hard to ventilate. Which action best improves ventilation?
Answer: A. Children swallow and accumulate air easily during bag-mask ventilation, and a distended stomach pushes the diaphragm up, limiting lung expansion. Gastric decompression through an orogastric tube restores compliance. Higher volumes worsen barotrauma, and pressing on the abdomen risks vomiting and aspiration.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- A BVM that will not move air is a seal problem until proven otherwise.
- Confirm placement by chest rise, breath sounds AND a sustained waveform together.
- Waveform SHAPE carries information: a sloping upstroke is bronchospasm.
- Abrupt loss of waveform is a displaced tube or arrest — never a nuisance alarm.
Field priorities
- Two-person BVM before escalating to a device.
- Rate discipline in arrest: hyperventilation reduces output.
Coaching the patient
- A forceful cough moves more air than any maneuver you can perform.
Red flags: act now
- Epigastric gurgling
- Progressive abdominal distension
- Waveform lost without explanation
Airway & Ventilation: FAQs
What are the priority actions for Airway & Ventilation in the field?
Two-person BVM before escalating to a device. Rate discipline in arrest: hyperventilation reduces output.
What findings in Airway & Ventilation change your plan or your transport decision?
Epigastric gurgling. Progressive abdominal distension. Waveform lost without explanation.
What do I need to know about Airway & Ventilation for the NREMT?
A BVM that will not move air is a seal problem until proven otherwise. Confirm placement by chest rise, breath sounds AND a sustained waveform together. Waveform SHAPE carries information: a sloping upstroke is bronchospasm. Abrupt loss of waveform is a displaced tube or arrest — never a nuisance alarm.
What should the crew communicate or document for Airway & Ventilation?
A forceful cough moves more air than any maneuver you can perform.
