Suction and the Obstructed Airway: Steps That Save the Save

You cannot ventilate through vomit. Suction is a resuscitation intervention, and on the NREMT it is graded as one.

Suction basics

• Rigid (Yankauer) for the oropharynx and thick secretions; soft French catheter for the nose or through an airway device.
• Measure depth: insert only as far as you can see, or to the depth of the OPA.
• Suction on withdrawal only, never on insertion.
• Limit to 10 seconds in adults, 5 in children, 3 in infants — then reoxygenate.
• Adult suction pressure around 100–150 mmHg; lower for pediatrics.

Partial obstruction with good air exchange

The patient is coughing forcefully and speaking. Encourage coughing, give oxygen, monitor closely, and transport. Do not intervene with blind finger sweeps or back blows — you risk converting it to complete.

Complete obstruction, conscious

1. Adults and children over 1 year: abdominal thrusts until relief or unresponsiveness.
2. Infants under 1 year: alternate 5 back slaps and 5 chest thrusts.
3. Pregnant or morbidly obese patients: chest thrusts in place of abdominal thrusts.

Complete obstruction, unresponsive

Start CPR. Before each set of ventilations, look in the mouth and remove a visible object. Continue compressions between attempts — compressions generate the pressure that most often expels the object. Never blind finger sweep.

Advanced options

Paramedics may use direct laryngoscopy with Magill forceps for a visualized supraglottic foreign body. A truly unrelievable obstruction below the cords is a surgical airway problem — recognize it and transport aggressively.

Exam pattern

Gurgling on ventilation always means suction before the next breath. If the patient becomes unresponsive during choking care, the answer moves to CPR — not more abdominal thrusts.