You are treating an unconscious patient with an unsecure airway. Thus far, you have had to maintain the airway using a head-tilt, chin-lift maneuver. You now prepare to move the patient and must negotiate a series of turns in a narrow hallway to get out of the house. What steps can you take to ensure the airway remains patent during extrication?
The Correct Answer and Explanation is:
Correct Answer:
Use an oropharyngeal airway (OPA) and maintain manual airway positioning as needed during movement.
Explanation:
In an unconscious patient with an unsecured airway, maintaining a patent airway is a top priority, especially during movement or extrication. When a person loses consciousness, muscle tone in the tongue and pharynx decreases, allowing the tongue to fall back and block the airway. Initially, airway patency may be preserved with manual maneuvers such as the head-tilt, chin-lift or jaw-thrust (in trauma cases). However, these maneuvers are difficult to maintain consistently, particularly while moving the patient through narrow or complex spaces.
To ensure continued airway patency during extrication, the best course of action is to insert an oropharyngeal airway (OPA). An OPA is a rigid device that holds the tongue away from the posterior pharynx, thereby preventing airway obstruction. It is particularly effective in unconscious patients who lack a gag reflex, as its use in semi-conscious patients may cause vomiting or laryngospasm.
Once the OPA is in place, the airway remains more stable during movement, although continuous monitoring is still essential. The rescuer must also be prepared to adjust the head position manually as needed, especially when going around corners or changing the patient’s orientation. If spinal injury is suspected, the jaw-thrust maneuver should be used instead of the head-tilt, chin-lift, and spinal precautions must be maintained.
If skilled personnel and equipment are available, a nasopharyngeal airway (NPA) or advanced airway management (e.g., supraglottic airway or endotracheal tube) may be considered, depending on the patient’s condition and setting. However, the OPA remains a quick, effective, and easily inserted tool during initial extrication.
In summary, inserting an OPA before moving the patient ensures the airway stays open and reduces the risk of obstruction during transport through confined or challenging spaces.