Airway Adjuncts and Supraglottic Airway Devices - NREMT AEMT Level

Identify the preferred airway positioning maneuver for an adult without suspected spinal injury.

Head tilt–chin lift. This maneuver extends the neck and lifts the chin to align oral, pharyngeal, and tracheal axes for optimal airflow.
What is the primary purpose of an airway adjunct such as an OPA or NPA?

Maintain airway patency by preventing tongue obstruction. These adjuncts displace the tongue anteriorly to ensure an open pathway for air exchange in compromised patients.
What is the correct OPA insertion technique for an adult to avoid pushing the tongue posteriorly?

Insert upside down, rotate $180^\circ$ as it advances. Inserting inverted and rotating follows the palate's curve, preventing the tongue from being pushed back into the airway.
Which OPA insertion technique is preferred for infants and small children?

Insert with tongue depressor; do not rotate. Using a tongue depressor allows direct, non-rotational insertion to avoid trauma in smaller pediatric airways.
What is the most appropriate immediate action if you cannot ventilate effectively after supraglottic placement?

Remove device and ventilate with BVM. Immediate removal and BVM use restores basic ventilation when supraglottic device fails to provide adequate oxygenation.
What is the correct immediate action if significant resistance is met during NPA insertion?

Remove and attempt the other nare. Switching nares avoids forcing insertion, which could cause trauma or epistaxis if resistance indicates obstruction.
Which device is most appropriate to provide a conduit for suctioning and BVM ventilation in an unconscious patient with no gag?

Oropharyngeal airway (OPA). OPA maintains oropharyngeal patency in unconscious patients, facilitating suction and bag-valve-mask ventilation.
What complication is most associated with NPA placement in anticoagulated patients?

Epistaxis (nasal bleeding). Anticoagulated patients are prone to bleeding from nasal mucosa disruption during NPA insertion.
What is the correct action if a patient with an OPA develops gagging during ventilation?

Remove the OPA immediately. Prompt removal eliminates the stimulus causing gagging, preventing potential vomiting or laryngospasm during ventilation.
Identify the most common clinical sign that a supraglottic airway is malpositioned.

Significant air leak with poor chest rise. Malposition prevents proper seal, resulting in air escaping and inadequate lung inflation during ventilation attempts.
Which direction should the bevel face during NPA insertion to reduce turbinate trauma?

Bevel toward the septum. Facing the bevel medially aligns it with the nasal septum, minimizing trauma to the lateral turbinates during advancement.
What is the correct NPA sizing method using external landmarks?

Nose tip (nares) to earlobe (tragus). This landmark measurement confirms appropriate NPA length to reach from nostril to nasopharynx without excessive protrusion.
What is the correct OPA sizing method using external landmarks?

Mouth corner to earlobe (angle of mandible). This measurement ensures the OPA length matches the distance from lips to the angle of the jaw for proper pharyngeal positioning.
Which patient condition is the most appropriate indication for a supraglottic airway device?

Apneic or inadequate respirations needing ventilatory support. Supraglottic devices provide advanced ventilatory support for apneic patients when basic methods are insufficient.
Which airway adjunct is preferred when the patient has an intact gag reflex or is semi-conscious?

Nasopharyngeal airway (NPA). Preferred for patients with intact gag reflex as it is inserted nasally, bypassing oral structures that could trigger gagging.
What complication is most associated with placing an OPA in a patient with a gag reflex?

Vomiting and aspiration. OPA insertion in patients with gag reflex stimulates retching, increasing risk of emesis and pulmonary aspiration.
Identify the preferred airway maneuver when spinal injury is suspected and the airway must be opened.

Jaw-thrust maneuver. Displaces the mandible forward without cervical extension, minimizing risk of exacerbating spinal cord injury.
Identify the classic contraindication to NPA insertion for AEMT testing.

Suspected basilar skull fracture. Basilar skull fractures risk NPA entering the cranial cavity through the cribriform plate, potentially causing severe complications.
Which option best describes a key limitation of supraglottic airways compared with endotracheal tubes?

They do not definitively protect against aspiration. Unlike endotracheal tubes, supraglottic devices do not isolate the trachea, allowing potential regurgitation into the lungs.
Which finding is the best indicator that ventilation through a supraglottic airway is effective?

Sustained waveform capnography (ETCO $2$ ) with chest rise. Waveform capnography confirms CO2 expulsion, while chest rise verifies effective air delivery to the lungs.
Which patient scenario is a contraindication to supraglottic airway use in many protocols?

Known caustic ingestion or major airway obstruction. Caustic ingestion risks further tissue damage, and major obstruction may prevent proper device seating or ventilation.
Which airway device sits above the vocal cords and does not require laryngoscopy?

Supraglottic airway device. Positioned above the glottis, these devices allow blind insertion without need for vocal cord visualization.
Identify the primary contraindication to OPA placement.

Intact gag reflex (responsive patient). An intact gag reflex in responsive patients can lead to vomiting, laryngospasm, or aspiration upon OPA insertion.
Which airway adjunct is indicated for an unresponsive patient with no gag reflex?

Oropharyngeal airway (OPA). Indicated for unresponsive patients without gag reflex to prevent tongue from obstructing the posterior pharynx and maintain airway patency.

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