Note: Your progress in watching these videos WILL NOT be tracked. These training videos are the same videos you will experience when you take the full ProACLS Recertification program. You may begin the training for free at any time to start officially tracking your progress toward your certificate of completion.
In this lesson, we'll cover the exact procedure for inserting a basic airway. And at the end of the lesson, we'll provide you with a Word about bag-mask ventilation.
Basic airways are adjuncts that help direct air and oxygen around natural obstacles in the mouth, like the tongue. There are two types of basic airways:
- Oropharyngeal Airway (OPA) – OPAs are primarily used for patients who are usually unconscious and have no gag reflex.
- Nasopharyngeal Airway (NPA) – NPAs are basic airways that are inserted in patients who have a gag reflex and might be semi-conscious.
Pro Tip #1: The correct size of both OPAs and NPAs are very important in order to not cause further harm to the patient, or in some cases, even block the airway entirely. To measure for an OPA, connect or place the tip of the flange to the side of patient's mouth and the base of the curved plastic to the earlobe area.
As mentioned briefly above, it's important to check the patient for a gag reflex if you're not sure about their level of consciousness and responsiveness. A trick of the trade for checking for a gag reflex is to rub the patient's eyelid and see if they have a blinking reflex.
If you notice that they do, you should opt for an NPA as the patient will be better able to tolerate it while/if they are still somewhat conscious. To measure for an NPA, hold the airway next to the patient's face and gauge the length from the edge of the nostril to the earlobe.
However, if you're certain that the patient is unresponsive and there isn't a gag reflex, prepare a properly sized OPA as indicated in the Pro Tip above.
Pro Tip #2: Make sure you have either a portable suction device or a battery-operated or regular concurrent suction catheter. Once you begin to insert the OPA, if the patient does have a gag reflex, they could vomit, and you'll need to clean that out of their airway. Alternatively, you may notice some blood, mucous, or something else in the airway that you'll need to suction.
It's important to note that when suctioning the patient's airway, you should never take longer than 10 seconds at a time before oxygenating the patient again.
Procedure for Inserting an OPA
You may want to consider re-watching the corresponding video lesson for the exact procedure as watching will always be superior to reading.
- Make sure you perform a head tilt chin lift on the patient.
- Invert the OPA tube, so the end or tip follows the roof of the mouth and continue to insert downward until it gets closer to the back of the oral pharynx.
- Twist the OPA tube a full 180 degrees as you continue to insert it further and until it's in place.
Pro Tip #3: If you're wondering why you begin by inserting the OPA tube backward, essentially, it's done this way to help move the patient's tongue out of the way and bring it forward. This will better allow you to put air behind the tongue and into the lungs.
A Word About Bag-Mask Ventilation
A bag-mask ventilation device consists of a ventilation bag attached to a face mask. Bag mask ventilation devices have been a mainstay of emergency ventilation for decades and are the most common method of providing positive-pressure ventilation.
When using a bag-mask ventilation device, you should deliver approximately 600ml of tidal volume sufficient to produce the patient's chest to rise over one full second. It's important to note that bag-mask ventilation is not the recommended method of ventilation for a single healthcare provider while they are also administering CPR.
Instead, a single healthcare provider should use a pocket mask to provide ventilations, if one is available. It's much easier for two trained rescuers to provide bag-mask ventilation, as one rescuer can open the airway and seal the mask to the patient's face while the other squeezes the bag. And when there are two rescuers, both should be watching for visible chest rise.
The universal connections that are present on all airway devices will allow you to connect any ventilation bag to numerous adjuncts. Valves and ports can include:
- One-way valves to prevent the patient from rebreathing exhaled air
- Oxygen ports for administering supplemental oxygen
- Medication ports for administering medications
- Suction ports for clearing the patient's airway
- Ports for quantitative sampling of end-tidal CO2
You can also attach other adjuncts to the patient end of the valve, including a pocket face mask, laryngeal mask airway, laryngeal tube, esophageal tracheal tube, and an endotracheal tube.
