If a patient with a strong gag reflex refuses an oropharyngeal airway, what is your next step in securing the airway?

• A. Inserting an NPA.
• B. Performing a head-tilt-chin lift.
• C. Performing a modified jaw thrust.
• D. Set up an IV.

Answer: (A)

When a strong gag reflex prevents placing an oral airway, bypassing the mouth with a nasal airway is the next step to secure the airway. A nasopharyngeal airway sits through the nasal passage and helps keep the tongue from obstructing the airway without triggering the gag reflex, which is especially useful in a conscious or semi-conscious patient who won’t tolerate an oropharyngeal airway. Before inserting, assess nasal patency and look for contraindications such as suspected basal skull fracture, significant facial trauma, or active epistaxis. If it’s appropriate, choose the correct size (often from nostril to the angle of the jaw or ear lobe), lubricate well, insert with the bevel toward the nasal septum, and advance gently along the floor of the nasal cavity until the flange rests outside the nostril. If you meet resistance or the patient develops discomfort, stop and reassess. The other maneuvers and an IV setup don’t secure the airway in this scenario; they may help with opening the airway or providing access for meds, but they don’t bypass the gag reflex in the same way a nasal airway does.