NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 6028

POLICIES AND PROCEDURES

Subject: Medical Direction

Basic Life Support Treatment Guidelines

Airway Adjunct Procedure

Associated Policies: 02/15/98

  1. Scope of Practice - Airway Adjuncts:
  1. First Responder scope of practice permits the use of oropharyngeal airways (OPA) and nasopharyngeal airways (NPA).
  1. Indication:
  1. Decreased level of consciousness/ suppressed gag reflex.
  1. Contraindication:
  1. Absolute:
  1. Oral Airway - Presence of a gag reflex.
  2. Nasal Airway - Any head or facial trauma. Child less then 1 year of age.
  1. Procedure:
  1. Assemble equipment near patient: OPA/ NPA, oxygen, bag valve mask, and suction.
  2. Determine proper size:
  1. OPA - measure from the ear lobe to the corner of the mouth, or from the angle of the jaw to midline of the lips. DO NOT USE AN UNDERSIZED OPA, AS THERE IS RISK OF ASPIRATING THE AIRWAY.
  2. NPA - measure from the tip of the nostril to the tragus (cartilaginous bump) of the ear.
  1. Insertion:
  1. OPA - Gently insert the OPA upside down into the mouth, and advance the airway until resistance is met at the pharynx. When resistance is met, rotate the OPA 180º (right side up) while inserting remainder of airway or insert directly using tongue depressor to compress tongue.
  2. NPA - Lubricate NPA with water soluble lubricant, and push up the tip of the nose to widen the nostrils. Insert into the larger or right nostril with the beveled side towards the septum. Angle the tip of the NPA at 45º above the base. Gently guide the NPA through the nostril while bringing it to a 90º angle to the patient. Aim the tip of the NPA at C-1 and insert the remainder of the airway while rotating the airway back and forth between the fingertips. Do not attempt to force an NPA past resistance. Remove it and try the other nostril.
  1. Special Instructions:
  1. DO NOT USE AN UNDERSIZED OPA.
  2. Stimulation of an eyelash reflex is indicative of a gag reflex.
  3. Improper insertion of OPAs may push the tongue into the posterior pharynx and create an airway obstruction.
  4. Vigorous insertion of NPAs may cause severe nosebleeds.