Airway, Respiration, and Ventilation on the NREMT Paramedic Exam

A separate domain at the Paramedic level

On the National Registry Paramedic Certification Examination, Airway, Respiration & Ventilation is one of six domains, at 8–12% of the exam. Like the other clinical domains it samples three knowledge areas, assessment, pathophysiology and management, and the test plan integrates pediatric items into it. The EMT exam's current blueprint is organized differently, so an EMT airway guide will not map onto this one.

Airway decisions also come up inside cardiac arrest, which the AHA covers in its adult advanced life support guideline. Expect some overlap with Cardiology & Resuscitation and with Clinical Judgment scenarios. The resuscitation sections follow the 2025 AHA guidelines; the pediatric upper-airway section uses the Royal Children's Hospital clinical guideline. Your protocols and medical director decide real care.

Confirming and monitoring an endotracheal tube

For adults in cardiac arrest, the 2025 guideline names continuous waveform capnography, used together with clinical assessment, as the most reliable method of confirming and monitoring correct endotracheal tube placement (COR 1). Two words in that sentence do the work on an exam:

• Continuous. The recommendation covers monitoring, not only a single check after placement.
• Together with clinical assessment. Capnography does not replace looking and listening; the two are paired.

Single findings, such as fogging in the tube, chest rise on a couple of breaths, or a rising pulse oximetry reading, are clinical signs. None of them is the method the guideline ranks as most reliable. Waveform capnography monitoring and interpretation are listed at the AEMT and paramedic levels in the National EMS Scope of Practice Model 2019, and endotracheal intubation at the paramedic level.

The free mixed set includes an item on confirming a tube placed during CPR. With the guideline's wording in mind, check the waveform-capnography tube-confirmation item in the free NREMT Paramedic set →.

Supraglottic or endotracheal during cardiac arrest

The 2025 adult guideline sets two conditions for advanced airways in arrest:

1. Timing. If placing an advanced airway will interrupt chest compressions, defer it until the patient fails to respond to initial CPR and defibrillation, or has ROSC (COR 1).
2. Device. If an advanced airway is used in out-of-hospital cardiac arrest, a supraglottic airway can be acceptable in settings with a low intubation success rate or few training opportunities (2a).

So the guideline does not rank one device above the other for every system. It ties the choice to how well a system intubates. An option that stops compressions to place a tube early runs against the timing rule. For the full arrest sequence, see the cardiac arrest guide.

Ventilation numbers and their conditions

The first row describes ventilation with a pulse. The same 10-per-minute rate is also used during adult CPR with an advanced airway and continuous compressions; do not confuse it with CPR without an advanced airway. The opioid rows pair ventilation with the antagonist, so an option that waits for naloxone to work before ventilating leaves the first recommendation undone. Newborn oxygen and cord clamping are covered in the OB/GYN and newborn guide.

Choking: the 2025 sequences by age

The 2025 guidelines changed the first step for conscious adults and set an alternating cycle for children:

At the paramedic level, the Scope of Practice Model adds removing an obstruction by direct laryngoscopy. The 2025 AHA changes guide lists the other airway rows that changed.

Croup and suspected epiglottitis: recognize a threatened airway

A barking cough and hoarseness suggest croup. High fever with drooling, difficulty swallowing or a muffled voice raises concern for a different, potentially serious upper-airway problem such as epiglottitis. These patterns guide assessment; they do not establish a diagnosis.

The Royal Children's Hospital guideline emphasizes minimizing distress and letting the child remain in the position that helps breathing. Avoid forcing a distressed child flat or provoking the airway with a tongue-depressor examination. Arrange urgent airway expertise and transport, with support ready if the child deteriorates.

Once you can tell the two apart from the signs alone, review the suspected-epiglottitis item in 20 mixed NREMT Paramedic questions →. The pediatrics guide covers the rest of the pediatric content.

Paramedic-only airway skills, and what sits outside certification

The National EMS Scope of Practice Model 2019 lists these airway skills at the paramedic level and not below:

• Endotracheal intubation
• Cricothyrotomy
• Needle chest decompression
• Removing an airway obstruction by direct laryngoscopy

Rapid sequence induction for intubation (RSI) is different. The model says some states legally permit it, but it is usually not taught in initial education and is not part of the certification process. The model also says its changes are not in effect until your state licensing authority and medical director adopt them, so state rules and local credentialing decide what you may do on the job.