After inserting an OPA in an unresponsive woman, the patient begins to gag. You should:

• A. Remove the airway and have suction ready
• B. Reinsert a larger OPA
• C. Leave in place and monitor
• D. Immediately perform chest compressions

Answer: (A)

When an airway adjunct that was placed in an unresponsive patient starts triggering a gag, the protective gag reflex is returning. That means the device is no longer tolerated and can lead to vomiting or aspiration if kept in place. The safest move is to remove the airway aid and have suction ready to clear any secretions or vomit, then reassess the airway and breathing and proceed with bag-mask ventilation if needed. Replacing with a larger airway would likely provoke further gagging, leaving it in place won’t protect the airway from aspiration, and chest compressions are only indicated if there is no pulse or the patient is in cardiac arrest.