Which airway adjunct is contraindicated if a basal skull fracture is suspected?

• A. Oropharyngeal airway is contraindicated in basal skull fracture
• B. Nasopharyngeal airway is contraindicated in gag reflex presence
• C. Nasopharyngeal airway is contraindicated in suspected basal skull fracture
• D. Oropharyngeal airway is contraindicated in conscious patients

Answer: (C)

Basal skull fractures create openings at the skull base that nasal devices could exploit. A nasopharyngeal airway travels through the nasal passage into the nasopharynx, and if a fracture is present, it could breach the skull base and enter the cranial cavity, risking brain injury or infection. Therefore, the nasal route is contraindicated when a basal skull fracture is suspected.

The oropharyngeal airway does not use the nasal route, so it is not ruled out by a suspected basal skull fracture (though it has its own use limits, such as being inappropriate in a conscious patient with a gag reflex). This distinction is why the nasopharyngeal airway is the one to avoid in this scenario.