Advanced Airway Management in BLS

While basic airway maneuvers are effective, healthcare providers must also be proficient in using airway adjuncts to maintain an open airway in unresponsive patients. This lesson covers the proper selection, insertion, and troubleshooting of oropharyngeal (OPA) and nasopharyngeal (NPA) airways.

1. Oropharyngeal Airway (OPA)

The oropharyngeal airway (OPA) helps maintain airway patency by preventing the tongue from blocking airflow.

When to Use an OPA:

• Unresponsive patients without a gag reflex.
• When bag-mask ventilation is required.

How to Insert an OPA:

1. Measure from the corner of the mouth to the earlobe for correct sizing.
2. Insert the OPA upside down (curved side up).
3. Rotate 180 degrees as it passes the soft palate.
4. Ensure proper fit and reassess airway patency.

When NOT to Use an OPA:

• If the patient has an intact gag reflex (risk of vomiting and aspiration).

2. Nasopharyngeal Airway (NPA)

The nasopharyngeal airway (NPA) is an alternative airway adjunct, especially useful when an OPA cannot be tolerated.

When to Use an NPA:

• Patients with a gag reflex who need airway support.
• Patients with jaw trauma where OPA insertion is not possible.

How to Insert an NPA:

1. Measure from the tip of the nose to the earlobe for correct sizing.
2. Lubricate the NPA with a water-based lubricant.
3. Insert the airway into the right nostril (bevel facing the septum) and advance gently.
4. Ensure proper placement and reassess airway patency.

When NOT to Use an NPA:

• Suspected basilar skull fracture (risk of intracranial insertion).
• Severe nasal trauma or obstruction.

Final Thoughts on Airway Management

By mastering both basic and advanced airway techniques, healthcare providers can ensure proper oxygenation while minimizing interruptions in CPR. Understanding when and how to use OPAs and NPAs is a critical skill in resuscitation.