NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationEasy
A 55-year-old male is found unresponsive with sonorous respirations and an SpO2 of 85%. He has no signs of trauma. After opening the airway with a head-tilt chin-lift maneuver, his SpO2 improves slightly to 88%, but sonorous respirations persist. What is the MOST appropriate next intervention to maintain airway patency?
- AAttempt nasopharyngeal airway (NPA) insertion.
- BPerform a cricothyrotomy.
- CInitiate bag-valve-mask ventilation.
- DInsert an oropharyngeal airway (OPA).
Show answer & explanationAnswer & explanation
Correct answer: D. Insert an oropharyngeal airway (OPA).
Sonorous respirations (snoring) indicate partial upper airway obstruction, often by the tongue. A head-tilt chin-lift improved the SpO2 slightly, but the snoring persists, meaning the airway is still not fully patent. An OPA is the most appropriate next step for an unresponsive patient without a gag reflex to lift the tongue off the posterior pharynx and maintain airway patency.
Why the other options are wrong
- A. An NPA is an option if an OPA is contraindicated (e.g., gag reflex) or not tolerated, but an OPA is generally preferred for complete tongue obstruction in an unresponsive patient.
- B. Cricothyrotomy is a surgical airway, reserved for complete airway obstruction that cannot be managed by less invasive means.
- C. BVM ventilation is for inadequate breathing, not primarily for maintaining airway patency in a spontaneously breathing patient who needs mechanical assistance.
Oropharyngeal Airway (OPA) Insertion
An OPA is a curved device inserted into the oropharynx to prevent the tongue from obstructing the airway in unresponsive patients without a gag reflex. It lifts the tongue off the posterior wall of the pharynx, creating a patent airway.
- Indicated for unresponsive patients without a gag reflex.
- Contraindicated if patient has a gag reflex or oral trauma.
- Proper sizing is crucial (corner of mouth to angle of mandible or earlobe).
- Can be inserted rotated 180 degrees then flipped, or directly with tongue depressor.
Memory trick: Snoring means tongue, OPA's the key, then breathe free.