Pre‐procedure

ActionRationale

1. 1.Show
   Assess the patient's consciousness level.
   Only attempt the insertion of an oropharyngeal airway (OPA) in an unconscious patient, as vomiting and laryngospasm may otherwise occur (RCUK [232], C).
2. 2.Show
   Open patient^’s mouth and assess for loose dental fixtures. Remove any ill‐fitting dentures. If foreign bodies are visible, remove with suction.
   To minimize airway obstruction while avoiding injury to the soft palate (Soar et al. [262], C).
3. 3.Show
   Perform the head tilt, chin lift manoeuvre: place one hand on the patient^’s forehead and tilt the head back gently, then place the fingertips of the other hand under the point of the patient^’s chin and gently lift upwards to stretch the anterior neck structures.

   Alternatively, if there is a suspected injury to the cervical spine, use a jaw thrust. Approach the patient superior from their head. Identify the angle of the mandible, and provide upward and forward pressure with fingers to lift the mandible. Using thumbs, slightly open the mouth by downward displacement of the chin.
   The position of the head and neck must be maintained to keep the airway patent and aligned (RCUK [232], C).

   To protect the integrity of the cervical spine while ensuring a patent airway (RCUK [232], C).
4. 4.Show
   Select an OPA with a length that corresponds to the vertical distance between the patient^’s incisors and the angle of the jaw/mandible (Action figure 12.70).
   An OPA that is too small will not maintain an open airway. An OPA that is too big may cause trauma, laryngospasm or worsening of the airway obstruction (Wittels [288], C).

Procedure

1. 5.Show
   Insert the OPA into the oral cavity in the ‘upside down’ position. Advance to the junction of the hard and soft palates, then rotate the OPA through 180 degrees. Once it has been rotated, advance the OPA into the oropharynx (Action figures 12.71 a and 12.71 b).
   The insertion technique avoids pushing the tongue back and downwards, potentially obstructing the airway (ERC [73], C).
2. 6.Show
   Ensure the flattened, reinforced section of the OPA is between the patient's teeth/gums and the flange is at the lips (Action figure 12.72).
   This indicates correct positioning and improves airway patency (RCUK [232], C).

Post‐procedure

1. 7.Show
   Remove the OPA if the patient gags or strains.
   This indicates that the patient is conscious and therefore unable to tolerate an airway adjunct. E