In an unconscious casualty without suspected basal skull fracture, which airway adjunct is preferred?

• A. Oropharyngeal airway
• B. Endotracheal tube
• C. Laryngeal mask airway
• D. Nasopharyngeal airway

Answer: (D)

In an unconscious casualty, you want an airway adjunct that is quick, minimizes airway obstruction, and is well tolerated without triggering reflexes. A nasopharyngeal airway fits this best because it enters through the nose into the pharynx, bypassing the tongue and oropharynx to keep the airway open. Its placement is generally easier and less stimulating than an oropharyngeal airway, and it allows effective ventilation with bag-valve devices and suction as needed. It’s a good first-line choice when there is no suspicion of basal skull fracture; if basal skull fracture were suspected, this route would be avoided. Endotracheal tubes and laryngeal masks are more invasive or less secure for initial management, making nasopharyngeal airway the preferred option in this scenario.