Advanced Cardiac Life Support (ACLS) Certification Course

ACLS Introduction

The Initial Assessment

ACLS Skills Training

ACLS Certification Exam

Basic Airway Adjuncts


The OPA is a J-shaped device that fits over the tongue to hold the soft hypopharyngeal structures and the tongue away from the posterior wall of the pharynx. OPA is used in individuals who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle. A properly sized and inserted OPA results in proper alignment with the glottis opening. If efforts to open the airway fail to provide and maintain a clear, unobstructed airway, then use the OPA in unconscious victims. An OPA should not be used in a conscious or semiconscious individual, because it can stimulate gagging, vomiting, and possible aspiration. The key assessment to determine if an OPA can be placed is to check if the individual has an intact cough and gag reflex. If so, do not use an OPA.


The NPA is a soft rubber or plastic uncuffed tube that provides a conduit for airflow between the nares and the pharynx. It is used as an alternative to an OPA in individuals who need a basic airway management adjunct. Unlike the oral airway, NPAs may be used in conscious or semiconscious individuals (individuals with intact cough and gag reflex). The NPA is indicated when insertion of an OPA is technically difficult or dangerous. NPA placement can be facilitated by the use of a lubricant. Never force placement of the NPA as severe nosebleeds may occur. If it does not fit in one nare, try the other side. Use caution or avoid placing NPAs in individuals with obvious facial fractures.


Suctioning is an essential component of maintaining a patent airway. Providers should suction the airway immediately if there are copious secretions, blood, or vomit. Attempts at suctioning should not exceed 10 seconds. To avoid hypoxemia, follow suctioning attempts with a short period of 100% oxygen administration. Monitor the individual’s heart rate, oxygen saturation, and clinical appearance during suctioning. If a change in monitoring parameters is seen, interrupt suctioning and administer oxygen until the heart rate returns to normal and until the clinical condition improves. Assist ventilation as warranted.

Only use an OPA in unresponsive individuals with NO cough or gag reflex. Otherwise, an OPA may stimulate vomiting, laryngeal spasm, or aspiration.

An NPA can be used in conscious individuals with intact cough and gag reflex. However, use carefully in individuals with facial trauma due to the risk of displacement.

Keep in mind that the individual is not receiving 100% oxygen while suctioning. Interrupt suctioning and administer oxygen if any deterioration in clinical picture is observed during suctioning.