Nasopharyngeal Airway to Protect Airway during Seizures

Airway protection is a critical concern in emergency medicine and first aid, particularly when dealing with conditions that compromise a person’s ability to breathe. The airway, which includes the nose, mouth, throat, and windpipe, must remain clear and open to allow air to flow into the lungs. When this pathway is blocked, it can lead to serious complications, including respiratory distress, hypoxia (lack of oxygen), or death. Airway management is especially challenging during specific medical emergencies, such as seizures, where normal muscle control is lost. In such cases, protective measures and, if necessary, the use of devices like the nasopharyngeal airway (NPA) play a vital role.

This article explores how to protect the airway in general, how seizures create unique risks to the airway, and how a nasopharyngeal airway can serve as an effective tool to maintain an open airway during or after a seizure.

How to Protect Airway

Protecting the airway refers to the steps taken to ensure that air can pass freely into and out of the lungs. Airway obstruction can occur for various reasons, including unconsciousness, trauma, or medical conditions such as strokes, allergic reactions, or seizures. The key to airway protection is ensuring the patency (openness) of the airway, which may involve:

A. Positioning the person in a way that promotes airflow.

B. Clearing the mouth and throat of obstructions such as foreign objects or fluids (e.g., vomit or blood).

C. Using devices like airway adjuncts when manual methods (such as head positioning) are insufficient.

Maintaining an open airway becomes especially critical in situations where a person cannot protect their own airway due to muscle relaxation or loss of consciousness.

Why Seizures Pose Unique Challenges to Airway Protection

Seizures, especially generalized tonic-clonic (grand mal) seizures, present specific risks to the airway because of the uncontrolled muscle activity and loss of normal protective reflexes that occur during these events. In a seizure, the brain experiences abnormal electrical activity, leading to widespread and involuntary muscle contractions. This can result in various airway-related complications:

A. Tongue Obstruction: During the convulsive phase, the person’s tongue may fall backward, blocking the airway, especially if they are lying on their back. This obstruction impedes airflow into the lungs.

B. Aspiration Risk: Seizures often lead to excessive saliva production, and in some cases, vomiting. The person is unable to swallow or clear these secretions during a seizure, increasing the risk of aspiration, where fluids enter the lungs instead of the stomach. This can lead to choking or even aspiration pneumonia.

C. Loss of Muscle Control: Involuntary movements, jaw clenching, or stiffening of the muscles may block the airway directly or make it difficult to assess and clear the airway.

D. Temporary Apnea: In some cases, seizures can temporarily stop breathing (apnea), further complicating the situation by depriving the brain of oxygen.

How to Protect Airway During Seizure

Understanding the unique risks that seizures pose to the airway allows us to take targeted steps to protect it. Here’s how you can protect someone’s airway during and immediately after a seizure:

1) Positioning (Recovery Position)

One of the most effective ways to protect the airway during a seizure is to place the person in the recovery position. This means turning the person gently onto their side. By doing this, you prevent the tongue from falling back and blocking the airway, and you allow any saliva, blood, or vomit to drain out of the mouth rather than being inhaled into the lungs.

2) Avoid Inserting Objects into the Mouth

Contrary to popular belief, you should never put anything into the mouth of a person having a seizure. There is a common myth that placing a spoon or bite guard in their mouth will prevent them from biting their tongue, but this action can cause further harm by breaking teeth or obstructing the airway. Additionally, you might injure yourself by placing your fingers or hands near your mouth.

3) Clearing the Area of Harmful Objects

As seizures often involve jerking and thrashing movements, clearing the surrounding area of harmful objects like furniture or sharp items is crucial. This reduces the risk of injury, allowing you to focus on maintaining the person’s airway and overall safety.

4) Monitoring Breathing

After the seizure ends, it is important to monitor the person’s breathing. If their breathing is irregular or stops altogether, you may need to perform CPR or provide rescue breathing. If the seizure lasts longer than five minutes, or if there are multiple seizures in rapid succession, call emergency services immediately.

Role of a Nasopharyngeal Airway (NPA) in Advanced Airway Management

In more severe cases, especially post-seizure when the person is unconscious or semi-conscious, manual methods of airway protection (like positioning) may not be enough. In such instances, an airway adjunct device like a nasopharyngeal airway (NPA) can be used to maintain the airway's patency.

What is a Nasopharyngeal Airway?

A nasopharyngeal airway is a soft, flexible tube inserted into one of the nasal passages. The tube extends from the nostril down to the pharynx (the back of the throat), ensuring that the airway remains open. It bypasses potential obstructions in the mouth, such as the tongue, which can fall back and block the airway, particularly in unconscious patients.

Why Use an NPA in Seizures?

The NPA is particularly useful in situations where the person cannot maintain their airway on their own, which often happens post-seizure when the person is in a postictal state (the period following a seizure). During this time, the individual may remain unconscious or semi-conscious, and the muscles responsible for keeping the airway open are relaxed. This increases the risk of airway obstruction, making the NPA an ideal solution.

How to use a Nasopharyngeal Airway (NPA)

The following are instructions on how to insert an npa.

1) Select the Right Size: Choose an NPA that is appropriate for the individual’s size. Typically, the length of the tube should be the same as the distance from the tip of the person’s nose to their earlobe.

2) Lubricate the Airway: Apply a water-based lubricant to the NPA. This helps reduce discomfort and allows for smoother insertion.

3) Insert the Airway: Gently insert the NPA into one of the nostrils, with the bevel (angled end) facing towards the septum (the middle part of the nose). Insert it slowly, following the natural curvature of the nasal passage. If resistance is encountered, do not force it. Try the other nostril instead.

4) Check for Proper Placement: Once the NPA is in place, ensure that air is flowing freely through the airway. You should hear or feel air moving at the end of the tube when the person breathes.

Using a nasopharyngeal airway should be done properly and the airway selected must meet various performance criteria. You can visit professional manufacturers’ websites to delve into the airway performance criteria or make enquires, such as website of Hangzhou Bever Medical Devices Co., Ltd.

Airway protection is a central concern in many medical emergencies, but it is especially critical during seizures because of the unique risks to the airway posed by muscle convulsions and loss of consciousness. Understanding how to protect the airway during a seizure provides the foundation for preventing complications such as choking or aspiration.

However, in more severe cases, manual airway protection methods may not be sufficient, particularly when the person remains unconscious after the seizure ends. This is where devices like the nasopharyngeal airway come into play. By using an NPA, healthcare providers or first responders can ensure the airway remains open even when normal muscle control is lost, bridging the gap between basic airway management and more advanced medical interventions.

Conclusion

The interconnected principles of airway protection, managing airway risks during seizures, and using tools like the nasopharyngeal airway form a comprehensive approach to ensuring respiratory safety. Understanding these concepts not only improves outcomes in emergency situations like seizures but also equips responders with the skills to act effectively and confidently. Whether you're a healthcare provider, a caregiver, or simply someone wanting to be prepared for emergencies, mastering these techniques is crucial to saving lives.