In a patient with suspected spinal injury and no gag reflex, when is an oropharyngeal airway appropriate?

• A. After performing jaw-thrust and manual inline stabilization.
• B. Before any airway maneuvers.
• C. Only after intubation.
• D. Never use an oropharyngeal airway.

Answer: (A)

In a trauma patient with suspected spinal injury, protecting the neck while opening the airway is essential. The jaw-thrust maneuver opens the airway and preserves spinal alignment when you apply manual inline stabilization. If the patient is unconscious and has no gag reflex, an oropharyngeal airway is appropriate after you’ve opened the airway with the jaw-thrust and maintained inline stabilization. It helps keep the tongue from blocking the airway and facilitates ventilation with a bag-valve mask. Placing it before airway maneuvers isn’t ideal because you need to secure the airway safely with spine precautions first; waiting until after intubation isn’t appropriate since the device serves to maintain an open airway prior to definitive airway control; and never using one ignores a basic airway patency need when gag reflex is absent.