An unresponsive, snoring 67-year-old patient has a gag reflex when a tongue depressor is used. What airway adjunct is indicated?

• A. Insert a Nasopharyngeal Airway
• B. Turn him to the recovery position
• C. Suction his airway
• D. Maintain head-tilt chin-lift

Answer: (A)

When a patient is unresponsive but has a gag reflex, an airway device that bypasses the oropharynx is preferred. An oropharyngeal airway would stimulate the gag reflex and could trigger vomiting or coughing, so it’s not ideal here. A nasopharyngeal airway fits because it is inserted through the nostril and sits above the oropharynx, effectively holding the tongue away from the posterior airway and keeping the airway open without provoking gagging. This helps a snoring patient whose airway is partially obstructed by the tongue, providing a more tolerable and reliable airway adjunct in this scenario.

Suctioning can clear secretions if present, turning to the recovery position may help drainage but doesn’t secure the airway, and maintaining head-tilt chin-lift opens the airway but doesn’t address the gag risk and is not an adjunct when the tongue is causing obstruction.