Which airway should i use

Avoid moving the neck and use only the jaw-thrust maneuver or chin lift without head tilt to manually facilitate opening of the upper airway. A: The head is flat on the stretcher; the airway is constricted.

B: The ear and sternal notch are aligned, with the face parallel to the ceiling in the sniffing position , opening the airway. Aligning the external auditory canal with the sternal notch may help open the upper airway and establishes the best position to view the airway if endotracheal intubation becomes necessary.

The degree of head elevation that best aligns the ear and sternal notch varies eg, none in children with large occiputs, a large degree in obese patients. Determine the appropriate size of the oropharyngeal airway. The tip of an appropriately sized airway should just reach the angle of the mandibular ramus. Next, begin inserting the airway into the mouth with the tip pointed to the roof of the mouth ie, concave up. To avoid cutting the lips, be careful not to pinch the lips between the teeth and the airway as you insert the airway.

Rotate the airway degrees as you advance it into the posterior oropharynx. This technique prevents the airway from pushing the tongue backwards during insertion and further obstructing the airway.

Alternatively, use a tongue blade to depress the tongue as you insert the airway with the tip pointed to the floor of the mouth ie, concave down.

Use of the tongue blade prevents the airway from pushing the tongue backward during insertion. Monitor the patient and identify and remediate any impediments to proper ventilation and oxygenation.

Secure the oropharyngeal airway if it should remain in place eg, during mechanical ventilation after oral endotracheal intubation.

Use an oropharyngeal airway only if the patient is unconscious or minimally responsive because it may stimulate gagging, which poses a risk of aspiration. Nasopharyngeal airways are preferred for obtunded patients with intact gag reflexes. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.

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Common Health Topics. Videos Figures Images Quizzes Symptoms. Additional Considerations. Relevant Anatomy. Step-by-Step Description of Procedure. Warnings and Common Errors. Test your knowledge. Prior to beginning tracheal intubation, it is important to first correctly position the patient, prepare the medical equipment, and do which of the following additional actions?

More Content. Click here for Patient Education. Proper patient positioning. Be sure to suction the airway as needed. When using a nasopharyngeal airway, selecting the proper size is also important.

If the NPA is too long, it will either enter the larynx and irritate the coughing and gag reflexes, or be inserted into the vallecula, possibly causing an airway obstruction.

The distal tip of the NPA is properly placed beyond the tongue base but should not be in contact with the epiglottis. It has been suggested that the ideal position for the NPA tip is 1 cm above the epiglottis.

An NPA should be inserted with the bevel pointing towards the septum and following the natural curvature of the floor of the nasal cavity as it is advanced. Adequate application of a water-based lubricant to the outside of the NPA can facilitate a less traumatic insertion. Once the device is inserted, the flange should rest on the nostril opening. Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated.

Patients that can cough still have a gag reflex and an OPA should not be used. If the patient has a foreign body obstructing the airway, an OPA should also not be used. NPAs should not be used on patients who have nasal fractures or an actively bleeding nose. In some cases, slight bleeding may occur when you insert the airway, which can be suctioned or wiped away. The American Red Cross.

Airways Adjuncts. Accessed January Function and Indication The oropharynx is the primary site of upper airway obstruction in unconscious or anesthetized patients.

Insertion and Procedures Although airways are simple to use, it is important to select an appropriate size. Determination of the appropriate sizes of oropharyngeal airways in adults: correlation with external facial measurements. European Journal of Anesthesiology.

Contraindications Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated. Tips Be gentle when inserting either an oropharyngeal or nasopharyngeal airway. Avoid forcing an oropharyngeal airway, which can lead to trauma to the lips and tongue.

Use caution when twisting the oropharyngeal degrees to avoid trauma along the hard palate. Use a water-soluble lubricant when inserting a nasopharyngeal airway. If resistance is felt during insertion of a nasopharyngeal airway, stop and try the other naris. A modified lengthened nasopharyngeal airway.

Journal of Clinical Anesthesia. Guedel AE. Determination of the appropriate oropharyngeal airway size in adults: Assessment using ventilation and an endoscopic view.