Preoxygenate before any attempt and keep oxygen flowing by nasal cannula during it (apneic oxygenation).
Before you read
Test yourself first: 5 questions
Question 1 of 5
While inserting a supraglottic airway in an apneic adult, which finding tells you it has been advanced to the correct depth?
Answer: A. Supraglottic devices are advanced blindly along the palate until the tip seats in the upper esophagus, marked by the depth line at the incisors or by firm resistance. Coughing or gagging means the patient has airway reflexes and should not have the device at all, saturation lags behind and says nothing about depth, and the pilot balloon only fills when you inflate the cuff.
Question 2 of 5
An unresponsive adult with no gag reflex needs an advanced airway. Which history makes a supraglottic airway that seats in the upper esophagus inappropriate?
Answer: A. Devices whose tip sits in the upper esophagus are contraindicated after caustic ingestion and with known esophageal disease, because the tip and cuff can perforate tissue that is already damaged. Asthma, a seizure history and alcohol intake do not affect the esophagus in that way; alcohol raises aspiration risk, which a supraglottic airway partly reduces rather than worsens.
Question 3 of 5
Compared with endotracheal intubation, insertion of a supraglottic airway is:
Answer: A. A supraglottic device is advanced along the palate into the hypopharynx by feel, which is why it can be placed quickly, with little training decay and without interrupting compressions. That same blindness is why confirmation afterward is not optional — nothing was seen to enter the trachea, so chest rise, breath sounds and a waveform have to prove it.
Question 4 of 5
After intubation the chest rises on the right with clear sounds there, sounds are absent on the left, and the waveform is good. The likely problem is:
Answer: A. The right mainstem leaves the trachea at a shallower angle, so a tube advanced too far goes there and ventilates one lung; withdrawing slowly until sounds equalize, then reconfirming and resecuring, fixes it. A good waveform rules out the esophagus, and a right tension pneumothorax would abolish the sounds on the right rather than the left.
Question 5 of 5
You are using in-line capnography between the bag and the mask while ventilating an apneic adult with no advanced airway. There is no waveform and the chest barely moves. This most likely means:
Answer: A. Capnography works through a mask and gives breath-by-breath feedback: no waveform with poor chest rise means air is not moving in and out, from a leaking seal or an obstructed airway, and you should reposition, add an adjunct and use two-person technique. The sensor is not limited to advanced airways, zero CO2 never means good ventilation, and oxygen flow does not erase a waveform.
Keep the streak going with more questions like these, each with a full rationale.
What is advanced airway & rsi concepts?
The examinable content is preparing for the attempt, confirming placement with waveform capnography, and knowing the rescue path when the first attempt fails.
Key points to remember
- Preoxygenate before any attempt and keep oxygen flowing by nasal cannula during it (apneic oxygenation).
- Resuscitate before you intubate: correct hypoxia and hypotension first, because induction drops both.
- Waveform capnography is the most reliable confirmation of tube placement — and it must stay on.
- Failed attempt: go back to bag-mask or a supraglottic airway rather than repeating attempts.
- Cannot intubate, cannot oxygenate: surgical cricothyrotomy is the final step at the paramedic level.
Field priorities
- Position ear-to-sternal-notch with the face parallel to the ceiling before the attempt.
- Abort the attempt when oxygen saturation falls — reoxygenate, then reassess the plan.
- With an advanced airway in cardiac arrest: 1 breath every 6 seconds, compressions continuous.
Coaching the patient
- Sudden deterioration after intubation: DOPE — Displacement, Obstruction, Pneumothorax, Equipment failure.
Red flags: act now
- Loss of the capnography waveform after intubation
- Falling saturation during the attempt
- Hypotension before induction
Advanced Airway & RSI Concepts: FAQs
What are the priority actions for Advanced Airway & RSI Concepts in the field?
Position ear-to-sternal-notch with the face parallel to the ceiling before the attempt. Abort the attempt when oxygen saturation falls — reoxygenate, then reassess the plan. With an advanced airway in cardiac arrest: 1 breath every 6 seconds, compressions continuous.
What findings in Advanced Airway & RSI Concepts change your plan or your transport decision?
Loss of the capnography waveform after intubation. Falling saturation during the attempt. Hypotension before induction.
What do I need to know about Advanced Airway & RSI Concepts for the NREMT?
Preoxygenate before any attempt and keep oxygen flowing by nasal cannula during it (apneic oxygenation). Resuscitate before you intubate: correct hypoxia and hypotension first, because induction drops both. Waveform capnography is the most reliable confirmation of tube placement — and it must stay on. Failed attempt: go back to bag-mask or a supraglottic airway rather than repeating attempts.
What should the crew communicate or document for Advanced Airway & RSI Concepts?
Sudden deterioration after intubation: DOPE — Displacement, Obstruction, Pneumothorax, Equipment failure.
