A 19-year-old female is unconscious and you insert an oropharyngeal airway, but she begins to gag violently. What is the best immediate action?

• A. continue to insert the airway as you suction
• B. remove the airway and be prepared to suction her oropharynx
• C. insert the airway no further but leave it in place as a bite block
• D. select a smaller oropharyngeal airway and attempt to insert it

Answer: (B)

Gagging during airway manipulation shows the airway device is provoking a protective reflex and raising the risk of vomiting and aspiration. The immediate priority is to protect the airway, so remove the oropharyngeal airway to stop stimulation. Be prepared to suction the oropharynx to clear any secretions or vomitus once the device is out. After that, reassess the patient and pursue another airway strategy if needed, such as a different size or a more definitive airway method. Continuing to push the airway in would worsen the gagging and increase aspiration risk, and leaving it in place as a bite block or trying a smaller size would not address the immediate threat.