An oropharyngeal airway is contraindicated in which patient scenario?

• A. Unresponsive patient with no gag reflex
• B. Awake patient with gag reflex
• C. Patient with nasal fracture
• D. Pediatric patient with no gag reflex

Answer: (B)

An oropharyngeal airway is used to keep the airway open by preventing the tongue from occluding the pharynx, and it only works well when the patient has lost protective airway reflexes. If the patient is awake and has a gag reflex, inserting this device can trigger a strong gag response, coughing, and vomiting, which can lead to aspiration rather than improve airway patency. That makes the this scenario—an awake patient with a gag reflex—the contraindicated situation.

The other scenarios fit or are neutral with respect to OPA use: an unresponsive patient without a gag reflex is a classic indication because the protective reflexes are absent; a nasal fracture affects the nasopharyngeal route (not the oropharyngeal one) and doesn’t by itself contraindicate an OPA; a pediatric patient without a gag reflex can still be managed with an appropriately sized OPA.