When should a paramedic consider using a nasopharyngeal airway?

A nasopharyngeal airway (NPA) is a flexible tube that is inserted into the nasal passage to secure an open airway. It is particularly useful in certain scenarios depending on the patient’s level of consciousness and airway reflexes.

In the case of a patient who is unconscious but retains a gag reflex, using an NPA is appropriate because the presence of the gag reflex indicates that the airway reflexes are somewhat intact, allowing for the use of this device without the immediate risk of causing aspiration. The NPA can help maintain an open airway, ensuring that air can pass freely to the lungs, which is critical in an unconscious patient who cannot protect their own airway.

While using an NPA in patients who are breathing normally or are conscious and cooperative may not be indicated because their airways are already patent and can be managed without adjuncts, in those unconscious situations where the gag reflex is present, the NPA becomes a valuable tool. Using an NPA in a patient with a tracheostomy, however, would be inappropriate, as the airway is already bypassed and managed through the tracheostomy, making additional airway adjuncts unnecessary.

This is why considering the specific conditions—unconscious state coupled with a functioning gag