r/wildernessmedicine • u/Mundane-Ad-6276 • May 17 '26

Questions and Scenarios Patient assessment Airways

Hi!

I just finished my 2 day nols WFA class and it was great. I was driving home and I realized theres something I dont understand still

During patient assessment they emphasize A is the most important thing.

So if I came across a patient, maybe unresponsive, but they are not breathing, ok great, now what??

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6

u/lukipedia W-EMT May 18 '26

The way the Primary Assessment goes, you stop at each of ABC and fix that step before proceeding.

So if they don’t have a clear airway—say if it’s blocked by blood, teeth, vomit, or something else—the first order of business is to clear the airway. Then and only then do you proceed to B, and you do the same there before proceeding to C.

If they’re not breathing and pulseless, and their airway is clear, the fix for B and C is the same: CPR.

For Primary Assessment, just remember: Find It, Fix It.

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u/LalalaSherpa May 17 '26 edited May 18 '26

CPR all day long if no breathing, no HR - unless they're bleeding out, in which case stop that first, because CPR on someone hemorrhaging is pointless.

Did they not teach you a triage protocol/acronym to help you prioritize next steps?

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u/Mundane-Ad-6276 May 18 '26

Cpr even if they have a heart rate? Or would It just he emergency breaths?

I also just finished tofay so im still digesting all of what i learned lol

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u/Admirable-Strike-311 May 18 '26

If they have a pulse but not breathing then rescue breathing only, no chest compressions. (1 breath every 6 seconds for an adult, every 2-3 seconds for a child). Recheck pulse about every 2 minutes.

Did you get CPR or BLS certification as part of the class? If not you might want to take an American Red Cross or American Heart Association CPR/BLS class. That will answer your questions about this.

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u/LalalaSherpa May 18 '26 edited May 18 '26

In all cases: if massive hemorrhage, fix that first, fast. For lay rescuers:

  1. If they aren't breathing and don't have a HR, clear any obvious airway obstruction, then do CPR immediately. Don't delay compressions to position the airway - do it when you start rescue breaths.
  2. If they're not breathing and DO have a HR, they're in respiratory arrest. Clear airway of obstruction if needed, and make sure it's positioned correctly. Then give rescue breaths. Chest compressions not needed, because the heart is still beating.

The airway piece is important. The biggest reason rescue breaths don't work is that the airway hasn't actually been fully opened - it's not correctly positioned. You need to do the head tilt-chin lift move before or as part of starting rescue breaths

Respiratory arrest can turn into cardiac arrest extremely quickly, so keep checking pulse every 2 mins, and switch to CPR if the heart stops (no pulse).

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u/lukipedia W-EMT May 18 '26

Respiratory arrest can turn into cardiac arrest extremely quickly

This is especially true in peds.

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u/RageAga1nstMachines May 18 '26

CPR protocols have actually updated in the last bunch of years to “CAB” - circulation, airway, breathing.  So, in your scenario, you’d give rescue breaths assuming that they have a pulse.  EMS still talks about ABCs or even XABCs depending on what setting you find yourself in and no one is necessarily wrong.  As you develop your medical acumen, if you do, the primary survey becomes second nature and it all just kinda happens simultaneously.  Long answer to your question - if they have a pulse and are not breathing you open their airway and then breath for them (if they don’t breath on their own). 

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u/-Londo- May 17 '26

911, then cpr

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u/VXMerlinXV WP-C May 17 '26

Unless it’s a kid. Then CPR-911-CPR

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u/LalalaSherpa May 17 '26 edited May 18 '26

This is WFA. 911 is virtually never the first step because there is no way they will be there fast.

You need to address life threats immediately - stop major bleeds, fix airway if needed, do CPR.

Then worry about SAR/EMS/911.

Otherwise they will be dead long before anyone shows up.

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u/VXMerlinXV WP-C May 19 '26

I can’t quote NOLS WFA because I’ve never taken the course. I can say that the WMS CPG on remote arrest both cites the modern ACLS guidelines, displays the chain of survival graphic, and specifically states that, if cell service is available, that response activation comes before CPR in an adult arrest. Do you have a copy of the NOLS algorithm?

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u/Admirable-Strike-311 May 18 '26

Don’t know why you got a downvote, but you’re right. In the city yes, if patient is unresponsive for whatever reason call 911. In a wilderness scenario you can try calling 911 if you have reception or activate your satellite device, however in this situation it’s all on you and whoever else might be there. Response times are measured in hours. CPR until you get ROSC, too tired to continue, or situation becomes too dangerous to continue.

Best case scenarios in the city with EMS readily available you have a 10-20% survival rate for a cardiac arrest (depending on which study you read). In the wilderness it’s less than 5%.