During an unconscious patient’s insertion of an oropharyngeal airway, the patient gags violently. What should you do first?

During an unconscious patient’s insertion of an oropharyngeal airway, the patient gags violently. What should you do first?

• A. Reinsert the airway and suction the oropharynx.
• B. Remove the airway and be prepared to suction her oropharynx.
• C. Continue ventilation with the airway in place.
• D. Proceed with a nasal airway instead.

Answer: (B)

Gagging during the insertion of an oropharyngeal airway shows the device is irritating the gag reflex and raises the risk of vomiting and aspiration. The first step is to remove the airway to stop that stimulation. Then immediately suction the oropharynx to clear any secretions or vomitus. Continuing to ventilate with the airway in place would push material toward the lungs, and reinserting the device while the patient is gagging would just provoke more gagging. After the airway is cleared and the patient’s airway risk is reassessed, you can decide on the next step, which may include trying a different airway approach if appropriate. A nasal airway isn’t an immediate fix for gagging during OPA insertion.

Gagging during the insertion of an oropharyngeal airway shows the device is irritating the gag reflex and raises the risk of vomiting and aspiration. The first step is to remove the airway to stop that stimulation. Then immediately suction the oropharynx to clear any secretions or vomitus. Continuing to ventilate with the airway in place would push material toward the lungs, and reinserting the device while the patient is gagging would just provoke more gagging. After the airway is cleared and the patient’s airway risk is reassessed, you can decide on the next step, which may include trying a different airway approach if appropriate. A nasal airway isn’t an immediate fix for gagging during OPA insertion.