What should be done if a patient with a gag reflex requires airway management?

When a patient has an intact gag reflex but requires airway management, the use of a nasopharyngeal airway (NPA) is appropriate because it is specifically designed for patients who maintain some level of consciousness and protective airway reflexes, including the gag reflex. An NPA can be tolerated better by these patients compared to an oropharyngeal airway (OPA), which can trigger vomiting and a gag response due to its placement in the oropharynx.

The NPA is inserted through the nose and extends into the pharynx, avoiding the area that stimulates the gag reflex, which allows for effective airway maintenance while minimizing the risk of airway obstruction or aspiration. It can be particularly useful in situations where immediate intubation is not feasible, yet the patient is unable to maintain their airway independently.

Administering supplemental oxygen alone wouldn't address the airway issue and may not provide adequate ventilation. Performing a tracheostomy is an invasive procedure that is typically reserved for situations where there is a prolonged need for airway management or significant anatomical obstruction, which is not indicated in this scenario.