An oral airway, also known as an oropharyngeal airway (OPA), is a curved device designed to help maintain an open breathing passage. When a person becomes unconscious, the muscles in their jaw relax, which can cause the tongue to fall back and block the airway, making breathing difficult or impossible. The OPA mechanically holds the tongue forward, ensuring a clear path for air to move in and out of the lungs.
Understanding Oral Airways: Purpose and Indications
Oral airways are used to alleviate upper airway obstruction in unconscious patients who cannot maintain their own airway. This device creates a clear channel for unimpeded airflow, facilitating ventilation during situations like resuscitation efforts or when soft tissue obstruction is evident. They are particularly useful for patients who are deeply obtunded and lack a gag reflex, ensuring continuous airway patency.
Preparation and Patient Assessment
Proper preparation and patient assessment are essential before inserting an oral airway. Selecting the correct size is critical, as an improperly sized airway can worsen an obstruction or cause injury. To size an OPA, measure from the corner of the patient’s mouth to the angle of their jaw or earlobe; the device should align with this distance. An airway that is too small might push the tongue further back, while one that is too large could cause trauma or stimulate gagging.
Assess the patient for contraindications before insertion. An OPA should only be used in unconscious patients without an intact gag reflex, as its presence can induce vomiting and aspiration risk. Contraindications include conscious patients, those with oral trauma, or suspected foreign body obstruction. Positioning the patient’s head with maneuvers like the head-tilt/chin-lift or jaw-thrust can help align the airway, with jaw-thrust preferred if a neck injury is suspected.
Oral Airway Insertion Steps
Before insertion, ensure the patient’s mouth is clear of any secretions or foreign material, suctioning if necessary. Carefully open the patient’s mouth, often using a cross-finger technique where the thumb is placed on the lower teeth and the index finger on the upper teeth to gently separate them.
One common method involves inserting the OPA upside down, with the curve facing the roof of the mouth. As the tip reaches the soft palate, rotate the airway 180 degrees so the curve faces downward, allowing it to settle over the tongue. This rotation prevents the OPA from pushing the tongue back and worsening obstruction. Advance the device until its flange rests against the patient’s lips. An alternative method, often for pediatric patients, uses a tongue depressor to hold the tongue down while inserting the OPA right-side up.
Post-Insertion Care and Monitoring
After insertion, confirm proper placement and continuously monitor the patient. Look for improved breathing, such as visible chest rise and fall, and listen for clear breath sounds. The patient should not gag or cough; this suggests the device is too large or the patient has an intact gag reflex, warranting immediate removal.
Continuously assess the patient’s airway, breathing, and circulation. The OPA can become dislodged with patient movement, requiring re-assessment and repositioning. If the patient regains consciousness and their gag reflex returns, or if a more advanced airway is established, gently remove the oral airway by pulling it out without rotation, following the natural curve of the mouth.
Essential Safety Considerations
An oral airway is a temporary measure and does not protect against aspiration of fluids like vomit or blood. This procedure requires proper training from qualified healthcare professionals. Paramedics, nurses, and doctors receive specific instruction and hands-on practice for safe and effective OPA insertion.
Performing OPA insertion without adequate training can lead to complications, including oral trauma, worsening airway obstruction, or inducing vomiting. Seek professional medical help immediately in emergency situations requiring airway management. The oral airway is an adjunct tool within a broader scope of emergency care, and its application should align with established protocols and continued patient assessment.