Now before you run away thinking you know all there is about the OPA, take a
minute and read on.

The use of the OPA is one of the first skills used in most EMS training. It
helps to secure the airway of an unconscious patient using basic methods and
allow for better oxygenation of the patient.

Too many times though many providers simply use a one size fits all approach
when placing an OPA. This has a few drawbacks and I think you would find
much better outcomes with your patient care if you take a few extra minutes
and select the appropriate size for your patient.

The Basics - an oral airway is a device that lifts the tongue off the
posterior pharynx, many times making it easier to ventilate a patient using
a bag valve mask. The inability to ventilate a patient is bad. Also a source
of O2 with a delivery mechanism (ambu-bag and mask) must be available.

The oropharyngeal airway is only used with an unconscious patient.
Do not insert the oropharyngeal airway if the patient is conscious or
semiconscious. The OPA could cause the patient to gag and vomit.

If you have an unconscious patient who becomes conscious remove the OPA.

Now I won't go too much into detail on placing an OPA but I do want to
mention a few of the possible negative outcomes by using an OPA especially
if not sized properly.

. Should the patient have a gag-reflex he/she may vomit
. If you use too large a size,  it can close the glottis and thus
close the airway
. Too large a size may cause bleeding in the airway

The above three scenarios are the main drawbacks and I think the primary
reasons for taking the time to size an OPA properly for each patient.

If the patient is conscious or semi conscious and vomits the danger in this
is that the patient could inhale some of the vomit which could then obstruct
his airway.

If the airway is not the correct size, it could injure the patients throat
or even obstruct his airway. The right size keeps the patients tongue from
falling down the back of his throat.

As a quick overview I want to just go over proper sizing of the OPA.

1- Place the oropharyngeal airway along the outside of the patients jaw
with one end of the airway at the bottom tip of the patients ear.

2 - Make sure the patients mouth is closed and bring the other tip of
the airway toward the corner of the patients mouth.

3 -  The airway should reach from the bottom tip of the patients ear
to the corner of the patients mouth.

4 - If the chosen OPA is too small or too large simply repeat the
steps using another oropharyngeal airway and choose the one that is nearest
the correct size.

Taking these quick steps will help you not only prevent incorrect sizing and
possible complications. They will also help you ventilate a patient much
more effectively improving your patients overall outcome.

As with anything else, by doing it on a regular basis, you will see that it
becomes easier and that you can perform the task quicker.

The A-Z series tries to promote the basics in EMS and while articles like
this may appear boring, they are the backbone of what we do in the field.
Having a firm understanding and knowledge of skills such as this will
guarantee that your advanced skills and training is put to good use.