If a patient is found unconscious with inadequate breathing and begins to gag during airway insertion, what should you do?

The scenario describes a patient who is unconscious with inadequate breathing and begins to gag during airway insertion. In this context, the gag reflex indicates that the airway insertion is causing discomfort or is inappropriate for the patient's current state, and continuing to insert the airway might risk causing harm or further complications.

Removing the airway and preparing to suction her oropharynx is the most appropriate action because it prioritizes the patient's safety. By removing the airway, you can reduce the risk of triggering more gagging, which could lead to aspiration or further compromise their airway status. Suctioning can help clear any secretions or vomit from the oropharynx, potentially improving airway patency and breathing once the environment is safer for further airway interventions.

Choosing to continue the insertion of the airway, even while suctioning, could exacerbate the situation by increasing the risk of trauma or aspiration. Selecting a smaller airway might not address the underlying issue of the gag reflex and could similarly pose a problem for the patient. Therefore, removing the airway and suctioning first helps to stabilize the situation for any subsequent airway management.