Which airway adjunct is appropriate for an unresponsive casualty without a gag reflex?

• A. Oropharyngeal airway
• B. Nasal airway
• C. Endotracheal tube
• D. Laryngoscope blade

Answer: (A)

Maintaining a patent airway in an unresponsive casualty without a gag reflex is best accomplished with an oropharyngeal airway. This device slides into the mouth to hold the tongue away from the back of the throat, creating a clear passage for air and making ventilation easier, especially when bagging. Because the patient has no gag reflex, insertion is less likely to provoke vomiting or coughing, and it can be placed quickly in the field. It’s a quick, noninvasive, inexpensive first-line option that helps prevent airway obstruction from the tongue.

The nasal airway is less ideal here because it can cause nasal trauma or bleeding and is less reliable for preventing tongue obstruction in an unconscious patient, especially if there’s facial injury or suspected basal skull fracture. An endotracheal tube provides a definitive airway but requires intubation skills and equipment, so it’s not an immediate adjunct. A laryngoscope blade isn’t an airway conduit on its own; it’s a tool used to visualize the larynx for intubation.