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Airway - Oropharyngeal airway

Indications

Upper airway obstruction requiring airway manoeuvres

and

Reduced left of consciousness

Contraindications (absolute in bold)

Nil

Alternatives

Nasopharyngeal airway

Laryngeal mask airway

Intubation

Informed consent

Medical emergency

Consent is not required

Potential complications

Failure to open airway

Vomiting (if gag reflex intact)

Airway obstruction (if incorrect placement causing posterior displacement of tongue)

Aspiration

Laryngospasm

Procedural hygiene

Standard precautions

PPE: non-sterile gloves, surgical mask, protective eyewear or shield

Area

Any

Staff

Procedural clinician

Equipment

Oropharyngeal airway (sized from corner of the patient’s mouth to tip of the earlobe)

Lubricant

Positioning

Neck flexion with atlanto-occipital extension (sniffing position), or

Neck in neutral position with spinal immobilisation (cervical injury suspected)

Head-tilt chin-lift or jaw thrust applied

In adults the sniffing position is achieved by elevating head approximately 10cm while tilting the head posteriorly. This achieves horizontal alignment of the sternum and external auditory meatus. Small children do not require head lift and infants will require slight elevation of the shoulders due to a relatively large occiput.

Medication

Nil

Sequence

Open the patient’s mouth with your thumb and index finger

Insert the inverted airway along the patient’s hard palate

Advance posteriorly until distal end entering hypopharynx, then rotate 180 degrees

Use a jaw thrust to aid passage if required

Advance until the flared external tip is as the oral orifice

Post-procedure care

Use definitive airway management if required

Tips

Oropharyngeal airways prevent the base of the tongue from obstructing the airway

When inserting an OPA, the clinician must avoid pushing the tongue into the posterior pharynx

Too small a device is ineffective, too large a device can press against the epiglottis obstructing the larynx

Nasopharyngeal or oropharyngeal airways should be considered with all bag-mask ventilation

Discussion

A tongue depressor can be used to move the tongue out of the way and pass the airway (instead of inverted insertion and rotation). This method may be considered with suspected oral or palate injury. It is generally not necessary.

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

Australian Resuscitation Council and New Zealand Resuscitation Council. ANZCOR guideline 11.6 – equipment and techniques in adult advanced life support. Melbourne: Australian Resuscitation Council and New Zealand Resuscitation Council; 2016. 16pp. Available from https://resus.org.au/guidelines/

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges' clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O'Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Wittels KA. Basic airway management in adults. In: UpToDate. Waltham (MA): UpToDate. 2019 Sept 17. Retrieved March 2019. Available from: https://www.uptodate.com/contents/basic-airway-management-in-adults

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