👤 By the CinnaEMS Content Team🕐 Updated 2026-09-24🏷️ Primary Assessment🔖 Free to read, print, and share
Also known as: OPA · NPA · Oropharyngeal airway · Nasopharyngeal airway
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Use this quick-reference guide to recognise, treat and hand over Airway Adjuncts on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Choose
Gag ABSENT → OPA
Gag INTACT → NPA
Basilar skull fx signs → nothing nasal
📌 Suction
On the way OUT only
≤10 seconds
Re-oxygenate between passes
📌 Size
OPA: mouth corner → earlobe
Too long = epiglottis over the airway
📚 Airway Adjuncts — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
The simple devices that keep an airway open once a manual maneuver has opened it, and the rules that stop them causing harm. Nearly every examinable error here is using the right device on the wrong patient.
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Key points
Understand these first
OPA for an absent gag; NPA when the gag is intact.
Neither nasally when basilar skull fracture is suspected.
Size the OPA mouth corner to earlobe — too long occludes with the epiglottis.
Suction on withdrawal only, ten seconds or less, then re-oxygenate.
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Nursing priorities
What to do, in order
Open the airway manually first — an adjunct holds a position, it does not create one.
Re-oxygenate between suction passes rather than extending one.
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Red flags — report now
Escalate immediately
Retching after OPA placement — remove it
Soot, hoarseness or singed hair after a burn
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Patient teaching
What patients must know
The NPA's whole advantage is that it is tolerated with a gag.
❓ Airway Adjuncts: NREMT FAQs
What are the priority actions for Airway Adjuncts in the field?
Open the airway manually first — an adjunct holds a position, it does not create one. Re-oxygenate between suction passes rather than extending one.
What findings in Airway Adjuncts change your plan or your transport decision?
Retching after OPA placement — remove it. Soot, hoarseness or singed hair after a burn.
What do I need to know about Airway Adjuncts for the NREMT?
OPA for an absent gag; NPA when the gag is intact. Neither nasally when basilar skull fracture is suspected. Size the OPA mouth corner to earlobe — too long occludes with the epiglottis. Suction on withdrawal only, ten seconds or less, then re-oxygenate.
What should the crew communicate or document for Airway Adjuncts?
The NPA's whole advantage is that it is tolerated with a gag.
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Quick Tip
OPA for an absent gag; NPA when the gag is intact.