Basic Airway Adjuncts

Although no adjunct can take the place of manual head positioning, adjuncts can help maintain an airway in patients who are unresponsive. They are designed to hold the tongue off the posterior wall of the pharynx.

Oropharyngeal Airway

Indications: The patient is unresponsive, breathing or not, without gag reflex.

Contraindications: A gag reflex is present.

Procedure:

1. Measure the airway from the corner of the mouth to the earlobe.
2. Open the mouth with the cross finger technique.
3. Insert the airway upside down until the distal tip reaches the soft palate.
4. Rotate the airway 180° with gentle pressure so that it slips under the tongue. The flange should rest against the lips.
   

Nasopharyngeal Airway

Indications: Patients who are unresponsive and patients with an altered mental status who have an intact gag reflex and cannot tolerate an oropharyngeal airway.

Contraindications: Facial or head trauma; a basal skull fracture is suspected or possible.

Procedure:

1. Measure the nasopharyngeal airway from the tip of the nose to the earlobe.
2. Lubricate the tip with water-based lubricant.
3. Select the larger nostril and apply gentle pressure posteriorly. A common error here is to aim the device superiorly, when the nasal passage is almost directly posterior to the nostril.
4. Advance the airway until the flange rests against the nose. If resistance is encountered, do not force it. Remove it and attempt the other nostril.
   

Pro-Tip

Oropharyngeal airways can be left in patients who have been intubated as a bite block. In the event the patient regains consciousness, seizes, or for some other reason experiences trismus (clenching of the jaw), this will prevent them from biting and crimping the ETT.