Basic Airway Skills

Oropharyngeal Airway

The oropharyngeal airway (OPA) is a J-shaped device that fits over the tongue to hold in place the delicate hypopharyngeal structures and keep the tongue away from the pharynx’s posterior wall. OPA is applied to people who are at risk of developing airway obstruction from the tongue or from a relaxed upper muscle.

OPA can be used in unconscious individuals in the event that a clear airway cannot be properly maintained or opened. It is not advisable to use OPA in conscious or semi-conscious people, as it can stimulate gagging and vomiting. It is important to assess if the patient has gag reflex or cough in order to determine whether the OPA can be used.

Nasopharyngeal Airway

The nasopharyngeal airway (NPA) is a soft rubber or plastic un-cuffed tube that serves as a conduit for airflow between the nares and the pharynx. It is used as an alternative to an OPA in cases where the individual is in need of a basic airway management support. Unlike the oral airway, an NPA can be used in conscious and semiconscious individuals, as well as persons with intact cough and gag reflex. The NPA is an alternative when the insertion of an OPA proves difficult or dangerous. Whenever applying an NPA to a person with evident facial fractures, rescuers should take precautionary measures to avoid further injuries.

Suctioning

To maintain a clear airway, suctioning is an important part of resuscitation. Blood, vomit, and other copious secretions must be sucked away immediately and should not exceed 10 seconds. Suctioning attempts should be made within a short period of 100-percent oxygen administration to avoid hypoxemia.

During this process, the patient’s heart rate, pulse oxygen saturation, and clinical appearance must be monitored. If a change is observable, the procedure must be interrupted and oxygen must be immediately administered until the patient’s condition is more stable. Assist ventilation as warranted.