NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationHard
A 50-year-old male is found unconscious with agonal respirations. His pulse is weak and thready at 120 bpm. You are preparing to insert a supraglottic airway device. Which of the following is an absolute contraindication for the insertion of a supraglottic airway?
- ASuspected cervical spine injury.
- BHistory of chronic obstructive pulmonary disease (COPD).
- CPresence of a gag reflex.
- DNeed for prolonged ventilatory support.
Show answer & explanationAnswer & explanation
Correct answer: C. Presence of a gag reflex.
The presence of an intact gag reflex is an absolute contraindication for supraglottic airway insertion. Attempting to insert the device in a patient with a gag reflex can induce vomiting, laryngospasm, and aspiration, severely compromising the airway and potentially leading to death.
Why the other options are wrong
- A. Supraglottic airways are generally considered safe and often preferred in suspected cervical spine injury compared to endotracheal intubation, as they require minimal head/neck manipulation.
- B. A history of COPD is not an absolute contraindication; supraglottic airways can be used in these patients, though proper ventilation parameters are crucial.
- D. While supraglottic airways are generally not ideal for very prolonged ventilatory support (e.g., days), this is a relative contraindication, not an absolute one, especially in the prehospital setting for initial stabilization.
Supraglottic Airway Contraindications
Supraglottic airway devices are used for airway management when endotracheal intubation is not feasible or indicated. Absolute contraindications primarily include an intact gag reflex, which can lead to complications such as vomiting and aspiration.
- Intact gag reflex is a major contraindication.
- Other contraindications include severe facial/airway trauma, foreign body obstruction.
- Relative contraindications: morbid obesity, prolonged use, high aspiration risk.
Memory trick: Gag Reflex Guards Against Supraglottic