A 55-year-old male is found unresponsive with sonorous respirations and an SpO2 of 85%. He has a strong radial pulse. After opening the airway with a head-tilt-chin-lift maneuver, his SpO2 improves to 92% and respirations become less noisy but remain shallow at 8 breaths per minute. What is the most appropriate next step in airway management?
- AInitiate bag-valve-mask (BVM) ventilations with 100% oxygen.
- BInsert an oropharyngeal airway (OPA) and continue monitoring.
- CPerform a cricothyroidotomy to secure the airway.
- DAdminister naloxone intravenously.
Show answer & explanationAnswer & explanation
Correct answer: B. Insert an oropharyngeal airway (OPA) and continue monitoring.
The initial improvement in SpO2 and reduction in noisy breathing after a head-tilt-chin-lift indicates an airway obstruction, likely by the tongue. While respirations are still shallow and slow, an OPA will help maintain airway patency, allowing for continued monitoring and potentially avoiding the need for immediate BVM if the patient's spontaneous breathing improves sufficiently. BVM would be indicated if respirations remain inadequate after OPA insertion.
Why the other options are wrong
- A. BVM ventilations are needed if breathing is inadequate, but an OPA should be attempted first to maintain the now-opened airway and assess if spontaneous breathing improves.
- C. Cricothyroidotomy is an invasive surgical airway procedure reserved for complete airway obstruction that cannot be managed by less invasive means; it is not indicated here.
- D. Naloxone is for suspected opioid overdose. While possible, maintaining a patent airway and addressing ventilatory issues takes precedence, and an OPA is a direct intervention for the described airway problem.
OPA for Airway Maintenance
An oropharyngeal airway (OPA) is a curved device inserted into the mouth to hold the tongue away from the posterior pharynx, preventing airway obstruction in unresponsive patients who lack a gag reflex.
- Used in unresponsive patients without a gag reflex.
- Helps maintain a patent airway after manual maneuvers.
- Proper sizing and insertion are crucial to avoid trauma or further obstruction.
Memory trick: Open, Place, Reassess Airway Patency