Podcast
Questions and Answers
What is the primary function of the oropharyngeal airway (OPA) in an unconscious patient?
What is the primary function of the oropharyngeal airway (OPA) in an unconscious patient?
Which part of the OPA is in direct contact with the tongue and rests on top of it?
Which part of the OPA is in direct contact with the tongue and rests on top of it?
Which type of oropharyngeal airway has channels that allow a suction catheter or endotracheal tube to slide into the pharyngeal space?
Which type of oropharyngeal airway has channels that allow a suction catheter or endotracheal tube to slide into the pharyngeal space?
What is a characteristic of the Guedel oropharyngeal airway?
What is a characteristic of the Guedel oropharyngeal airway?
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Why is an oropharyngeal airway NOT indicated for conscious patients?
Why is an oropharyngeal airway NOT indicated for conscious patients?
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What is a potential use of an OPA for intubated patients?
What is a potential use of an OPA for intubated patients?
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In case of an unconscious patient, an OPA can help prevent injuries to:
In case of an unconscious patient, an OPA can help prevent injuries to:
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Where does the tip of the OPA rest when properly inserted?
Where does the tip of the OPA rest when properly inserted?
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What should be considered when inserting an OPA in a seizing patient?
What should be considered when inserting an OPA in a seizing patient?
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What is the risk associated with inserting an oropharyngeal airway that is too long?
What is the risk associated with inserting an oropharyngeal airway that is too long?
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In the sizing of oropharyngeal airways, how is the correct length of the device verified?
In the sizing of oropharyngeal airways, how is the correct length of the device verified?
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What patient positioning is recommended when preparing to insert an oropharyngeal airway, provided cervical injury is not a concern?
What patient positioning is recommended when preparing to insert an oropharyngeal airway, provided cervical injury is not a concern?
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Why should dentures be removed before inserting an oropharyngeal airway?
Why should dentures be removed before inserting an oropharyngeal airway?
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What is the potential outcome of using an oropharyngeal airway that is too short?
What is the potential outcome of using an oropharyngeal airway that is too short?
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Which classification of patient size correlates with an OPA size 4-5?
Which classification of patient size correlates with an OPA size 4-5?
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Which method is recommended for opening the patient's mouth before inserting an OPA?
Which method is recommended for opening the patient's mouth before inserting an OPA?
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What is the first step before inserting an oropharyngeal airway to ensure a clear path?
What is the first step before inserting an oropharyngeal airway to ensure a clear path?
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Which term describes the perpendicular flange's alignment during OPA measurement?
Which term describes the perpendicular flange's alignment during OPA measurement?
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What should be done first when inserting an oropharyngeal airway (OPA) into a patient?
What should be done first when inserting an oropharyngeal airway (OPA) into a patient?
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Why is the OPA initially inserted with its convex curvature toward the tongue?
Why is the OPA initially inserted with its convex curvature toward the tongue?
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What action should be taken if the patient begins to retch or gag during the OPA insertion?
What action should be taken if the patient begins to retch or gag during the OPA insertion?
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At what point during OPA insertion is the airway rotated 180 degrees?
At what point during OPA insertion is the airway rotated 180 degrees?
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Which method is preferred for inserting an OPA in infants and children?
Which method is preferred for inserting an OPA in infants and children?
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What should the tip of the OPA point towards when it nears the posterior wall of the pharynx?
What should the tip of the OPA point towards when it nears the posterior wall of the pharynx?
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What is the purpose of the flange on an OPA?
What is the purpose of the flange on an OPA?
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How is the airway positioned when using a tongue blade to hold the tongue down?
How is the airway positioned when using a tongue blade to hold the tongue down?
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What should be avoided during the insertion of an OPA to prevent injury?
What should be avoided during the insertion of an OPA to prevent injury?
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What should you do if a patient gags or is gasping for air after the insertion of an OPA?
What should you do if a patient gags or is gasping for air after the insertion of an OPA?
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What can stridor, gasping, or snoring indicate after OPA insertion?
What can stridor, gasping, or snoring indicate after OPA insertion?
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Why should OPAs not be taped in place?
Why should OPAs not be taped in place?
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What should be frequently checked after the insertion of an OPA?
What should be frequently checked after the insertion of an OPA?
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What measures should be taken to clean an OPA for sub-acute or homecare use?
What measures should be taken to clean an OPA for sub-acute or homecare use?
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How should the lips and tongue of the patient be positioned in relation to the OPA?
How should the lips and tongue of the patient be positioned in relation to the OPA?
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What observation should be made to ensure equal lung function after OPA insertion?
What observation should be made to ensure equal lung function after OPA insertion?
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What is the proper method for removing an OPA?
What is the proper method for removing an OPA?
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In which scenario is the use of a nasopharyngeal airway (NPA) most appropriate?
In which scenario is the use of a nasopharyngeal airway (NPA) most appropriate?
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Which of the following is a contraindication for nasopharyngeal airway insertion?
Which of the following is a contraindication for nasopharyngeal airway insertion?
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What is the primary risk associated with NPA insertion in children?
What is the primary risk associated with NPA insertion in children?
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What is the most important size consideration for an NPA?
What is the most important size consideration for an NPA?
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Which of the following describes a potential issue with an NPA that is too long?
Which of the following describes a potential issue with an NPA that is too long?
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How is NPA length typically estimated?
How is NPA length typically estimated?
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What is a possible consequence of using an NPA that is too short?
What is a possible consequence of using an NPA that is too short?
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Where should the tip of a properly inserted NPA be located?
Where should the tip of a properly inserted NPA be located?
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What direction should the bevel of an NPA face during insertion according to most instructions?
What direction should the bevel of an NPA face during insertion according to most instructions?
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Why might clinicians not worry much about the bevel direction when inserting an NPA in the left nostril?
Why might clinicians not worry much about the bevel direction when inserting an NPA in the left nostril?
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When selecting a nostril for NPA insertion, which nostril is typically preferred?
When selecting a nostril for NPA insertion, which nostril is typically preferred?
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What should be done if excessive resistance is felt during the insertion of an NPA?
What should be done if excessive resistance is felt during the insertion of an NPA?
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What potential risk is increased by rotating the NPA during insertion according to the provided guidelines?
What potential risk is increased by rotating the NPA during insertion according to the provided guidelines?
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Why might the upside-down rotation procedure for NPA insertion be questioned in real-world applications?
Why might the upside-down rotation procedure for NPA insertion be questioned in real-world applications?
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How should the NPA be directed during insertion to match the natural anatomy of the nasal passageways?
How should the NPA be directed during insertion to match the natural anatomy of the nasal passageways?
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What alternative method can be used to facilitate the passage of the NPA into the oropharynx?
What alternative method can be used to facilitate the passage of the NPA into the oropharynx?
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Which tissues are particularly susceptible to damage during NPA insertion?
Which tissues are particularly susceptible to damage during NPA insertion?
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What should the curvature of the NPA match during insertion?
What should the curvature of the NPA match during insertion?
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What is a sign that the NPA has reached the posterior nasopharyngeal wall?
What is a sign that the NPA has reached the posterior nasopharyngeal wall?
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Which lubricant should be applied to the NPA tip before insertion?
Which lubricant should be applied to the NPA tip before insertion?
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What is the purpose of the O2 reservoir in a BVM system?
What is the purpose of the O2 reservoir in a BVM system?
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What is the recommended ventilation rate when performing CPR with an endotracheal tube?
What is the recommended ventilation rate when performing CPR with an endotracheal tube?
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What is a potential complication of high ventilation rates (greater than 12/min) during CPR?
What is a potential complication of high ventilation rates (greater than 12/min) during CPR?
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Why might COPD patients require a slower ventilation rate with a BVM?
Why might COPD patients require a slower ventilation rate with a BVM?
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What is barotrauma and why is it not usually a concern with adult BVMs?
What is barotrauma and why is it not usually a concern with adult BVMs?
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Study Notes
Oropharyngeal Airways (OPAs): Overview
- OPAs are simple devices used to restore patency in soft tissue airway obstruction in unconscious patients.
OPA Structure and Design
- OPAs are made of hard plastic, with a semicircular shape that conforms to the curvature of the palate.
- Each OPA has three parts: the flange, the body, and the tip.
- The body follows the contour of the roof of the mouth and rests on top of the tongue.
- The tip, the distal end, sits at the base of the tongue.
Types of OPAs
- There are two common types of OPAs: Berman and Guedel.
- The Berman OPA has channels along each side that allow a suction catheter or endotracheal tube to slide into the pharyngeal space.
- The Guedel OPA is a tubular device, its central lumen can be used for suctioning, but it cannot accommodate an ET tube.
Placement and Function
- When properly inserted, an OPA holds the tongue away from the posterior pharynx, allowing air to pass through and around the device.
- OPAs can be easily inserted at the bedside without instruments.
- OPAs facilitate suctioning in unconscious patients.
Indications and Contraindications
- OPAs are used to prevent patients from biting their tongue and the inside of their lips and cheeks.
- OPAs can be used as a bite block with intubated patients.
- OPAs are NOT indicated for conscious patients, as they could stimulate the pharyngeal reflex.
- OPAs are NOT indicated for patients who are actively seizing.
Oropharyngeal Airway Sizing
- Oropharyngeal Airway (OPA) size is based on patient's body size: • Large adult size: 5-6 • Medium adult size: 4-5 • Small adult size: 3-4
Measuring Technique
- Use the device itself as a measuring gauge: • Place the device on the patient's cheek, flange parallel to front teeth • Tip of the oropharyngeal airway should reach the angle of the jaw
Importance of Proper Sizing
- If the airway is too long, it could obstruct breathing by displacing the tongue against the oropharynx
- If the OPA is too short, it won't be able to hold the tongue away from the pharynx, and airway patency won't be restored
Insertion Technique
- Before insertion: • Suction the patient's mouth and pharynx to remove secretions • Place the patient in a supine or semi-Fowler's position and tilt the head back (unless contraindicated by cervical injury)
- With gloved hands: • Remove dentures • Prepare to insert the device
- Open the patient's mouth using the cross-finger method: • Place thumb on the bottom teeth and index finger on the upper teeth • Gently push the upper jaw (maxilla) and the lower jaw (mandible) apart
Oropharyngeal Airway Insertion
- Insert the airway upside down with the convex curvature toward the tongue to prevent pushing the tongue back into the pharynx.
- Gently slide the airway over the tongue with the tip toward the back of the mouth to avoid dislodging teeth or damaging mouth tissue.
- If the patient begins to retch or gag, remove the airway.
- When the airway reaches the base of the tongue, rotate the device 180 degrees so the tip points down as it approaches the posterior wall of the pharynx.
- The convex curvature should follow the contour of the roof of the mouth.
Alternative Method for Infants and Children
- Hold the airway in its normal upright position and use a tongue blade to hold the tongue down.
- Slide the airway carefully over the tongue and into position.
Description of the Oropharyngeal Airway
- The airway is a curved plastic tube with a flange at the proximal end.
- The airway is inserted upside down and then rotated into position to ensure the flange protrudes from the mouth and rests against the patient's lips.
- The convex curvature of the airway is aligned along the back of the tongue to prevent the patient's tongue from blocking the entrance to the trachea.
Oropharyngeal Airways (OPAs) Insertion and Care
- If a patient gags or gasps for air after OPA insertion, remove the airway and recheck the size before reinsertion
- Stridor, gasping, or snoring may indicate airway displacement or increasing respiratory distress
Key Considerations for OPA Use
- Ensure the patient's lips and tongue are not between their teeth and the OPA
- Auscultate the lungs and observe equal chest rise on both sides to confirm proper placement
- OPAs should not be taped in place, as this can lead to aspiration if the patient gags or coughs
Post-Insertion Care
- Frequently check the OPA's position to ensure proper placement
- Suction excess secretions as necessary and monitor the patient's respiratory status
- Remove the OPA periodically to prevent tissue irritation and ulceration of the mucous membranes of the mouth
OPA Removal and Cleaning
- Remove the OPA by gently pulling it outward and downward, following the mouth's natural curvature
- Clean the airway by rinsing it with hydrogen peroxide and water, and use a pipe cleaner or cotton swab to remove secretions from the side channels or central lumen
Nasopharyngeal Airway (NPA) Introduction and Sizing
- Indications for NPA include when oral airway is not possible, frequent nasotracheal suctioning is required, and to prevent Superior Turbinate Airway Obstruction (STAO) in patients recently extubated after facial surgery.
- Contraindications for NPA include patients on anticoagulants, basilar skull fractures, and nasal deformities.
- Children are at high risk for epistaxis (nosebleed) when an NPA is inserted.
NPA Characteristics and Insertion
- NPA is shaped to follow the natural curvature of the nasopharynx.
- When fully inserted, the tip is just above the epiglottis, separating the soft palate and tongue from the posterior wall of the oropharynx.
- Flexible nature of the airway and use of adequate water-soluble lubricant allows the airway to naturally find the proper position when inserted.
NPA Sizing
- NPA length is estimated as the distance from the nares to the external auditory meatus of the ears.
- NPA length is the most important size consideration.
- An NPA that is too short will not establish patency.
- An NPA that is too long may pass into the larynx, stimulating pharyngeal and laryngeal reflexes, or end up in the vallecular.
- Bevel of the NPA is on the right side of the airway.
- Bevel should face the septum during insertion (but not necessary for left nostril insertion).
Nasopharyngeal Airway (NPA) Insertion
- Identify the largest, most patent nostril (usually the right nostril) for NPA insertion.
- Apply a water-soluble lubricant to the NPA tip and insert it gently below the inferior turbinate and close to the septum, matching the curvature of the NPA to the natural anatomic curve.
- Direct the NPA straight back, as the nasal passageways go straight back.
- Avoid damaging lymphoid tissue around the sinuses and abrading the delicate nasal mucosa, which can cause bleeding.
- Resistance will be felt when the NPA meets the posterior nasopharyngeal wall.
- If necessary, slightly rotate the airway or pass a suction catheter through the NPA to guide it past the angle into the oropharynx.
- If excessive resistance is felt, withdraw the NPA, re-lubricate, and try the other nostril.
- Some procedures recommend inserting the NPA upside down (like an OPA) and then rotating it, especially for left nostril insertion.
- However, this method is often shown in drawings and with manikins, and may not be suitable for real-world use, as it can make insertion more difficult and increase the risk of trauma.
Introduction
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Description
Learn about Oropharyngeal Airways, devices used to restore patency in soft tissue airway obstruction in unconscious patients, including their structure and design.
