Which of the following is a contraindication for nasal airway use?

• A. Gag reflex present
• B. Nasal obstruction
• C. Basilar skull fracture
• D. Unconscious patient

Answer: (C)

Understanding when a nasal airway is appropriate hinges on whether the nasal route can be used safely without risking injury to the brain. The basilar skull fracture stands out because the nasal passage is directly connected to the skull base. If a fracture is present, inserting a nasal airway can breach the fractured base and allow the airway to enter the cranial cavity, potentially causing brain injury, meningitis, or other serious complications.

Nasal obstruction prevents placement, so the nasal route isn’t feasible but isn’t an inherent safety issue. An unconscious patient is often a good candidate for a nasal airway because the gag reflex is typically absent, reducing the risk of gagging or vomiting. A gag reflex being present is a factor to consider, but it’s not an absolute contraindication.