OPA Use

[Supermannnnnnn]

Quick question. Would it be appropriate to use a OPA on an unresponsive patient but not place them on any supplemental oxygen if they were breathing adequately and had good sats? What are your guys thoughts?

 

[OnceAnEMT]

I may be wrong, but I've never heard of someone breathing on their own with an OPA on board. That said, NRB at minimum if an OPA is indicated, and I've got the BVM sitting at the ear.

 

[gotbeerz001]

SpO2 is not sufficient for the unconscious pt in my mind. I have simply placed an OPA on an unconscious pt (OD, ETOH etc) and monitored ventilatory performance based on ETCO2 and SPO2.

If airway can be maintained with positioning and a simple adjunct and pt has adequate ventilatory performance, then we are good.

 

[Supermannnnnnn]

Thanks for the replies. Thinking about it now if a patient is ventilating and oxygenating appropriately they probably don't need an opa. A NPA and recovery position would probably do just fine.

 

[gnosis]

For a nonresponsive pt, I would have no problem placing an OPA in case their airway deteriorated. If they don't need ventilations, don't ventilate. Airway and breathing interventions don't have to come together.

 

[Tigger]

Alternatively you might stimulate their gag and cause them to vomit unnecessarily...

 

[EpiEMS]

NPA? Sure, probably not going to cause a problem. OPA? Probably not.

 

[gnosis]

Which is why we only put OPAs in unresponsive patients.

 

[Tigger]

Errr unresponsive patients still have the ability to gag and/or vomit.

 

[Nightmare]

I believe standard practice is to use the least invasive airway possible if the patient is able to ventilate on their own (if they are snoring or breathing normally but are unresponsive) so if an NPA secures the airway properly for you then that is what you use, now if they aren't breathing, you need an open airway that you can force air down...OPA or intubation. Also keep in mind the average human breathes primarily through their nose...so an NPA might better serve you when securing the airway.

 

[NomadicMedic]

I believe standard practice is to use the least invasive airway possible if the patient is able to ventilate on their own (if they are snoring or breathing normally but are unresponsive) so if an NPA secures the airway properly for you then that is what you use, now if they aren't breathing, you need an open airway that you can force air down...OPA or intubation. Also keep in mind the average human breathes primarily through their nose...so an NPA might better serve you when securing the airway.

Use the airway that allows you to provide effective ventilation. The choice is also easier with some experience. After you use a few, you'll know which to grab. I tend to only use an OPA in a cardiac arrest, simply because those folks have zero gag. If you're providing BVM ventilation, you're going to want all the help you can get, so use an OPA and a couple of NPAs. Bagging an opiate OD? Use an NPA until the Narcan works, then pull it.

Also, the idea that an NPA is a better choice because "adults primarily breathe through their nose" is false. Infants are obligate nose breathers, but ventilating any human via the oropharynx is effective and acceptable. (Unless, of course, it's impossible due to trauma or obstruction... But in that case, you've got other, more pressing problems.)

 

[grind time medic]

yes, you can place an OPA and if tolerated (not gagging or vomiting) not give o2. The OPA is establishing the way for the ambient o2 a path to be brought into the lungs by the muscilature of the chest. The debate about NPA and OPA in a unresponsive patient is more about preference (how the patient is cared for) than principle (what is true for all patients to see improvement or survive).

 

[Tigger]

Err there are definitely times when certain airway adjuncts are more preferable than others, and it's not a matter of a preference. If you anticipate that someone is going to regain their gag, you should not be placing an OPA.

Not to mention that it's rather rare for someone to be unconscious enough to not be able to maintain their airway and require an adjunct but not ventilation. Sure it couldhappen, but that is not a likely event.

 

[gronch]

Leaving the O2 part out of the equation, is there research on whether 2 NPAs and 1 OPA improves respiration?

 

[jwk]

Leaving the O2 part out of the equation, is there research on whether 2 NPAs and 1 OPA improves respiration?

Using 2 NPA's and an OPA is pointless.

 

[cprted]

And as a reminder, OPAs and NPAs are airway adjuncts, they help us manage the airway, they don't do it for us. In many cases, even with an OPA or NPA in place, you still have to maintain a jaw thrust or head-tilt/chin lift to keep the airway open. There are some good CT images of airway use and the difference in various techniques, I'll see if I can find them.

 

[Tigger]

Using 2 NPA's and an OPA is pointless.

That is our new passive oxygenation protocol, though I cannot find any research to support using three adjuncts.

 

[EpiEMS]

That is our new passive oxygenation protocol, though I cannot find any research to support using three adjuncts.

If one is good, two is better, and three fills up all the holes?

In all seriousness, if I'm running a BLS arrest with enough personnel, and there's good ventilation with BVM + OPAwith supplemental O2, good CPR in progress, and an AED attached, I don't see why *not* to stick in an extra NPA...

If it's respiratory distress, but the patient is conscious and being BVM'ed, why not double up on the NPAs, assuming they're tolerated? (I realize "why not" isn't necessarily evidence based -- on the other hand, I can't imagine that any harm would occur...)

 

[Clare]

Using 2 NPA's and an OPA is pointless.

I've seen a patient with two NPAs and an OPA in situ - it's called the hedgehog look!

Also, whatever adjunct you have won't improve respiration; it will (hopefully!) improve oxygenation. In the short term sub optimal ventilation can be tolerated provided that the oxygenation is satisfactory. And as a timely remind, oxygenation and ventilation are not the same thing.

 

[gotbeerz001]

I've seen a patient with two NPAs and an OPA in situ - it's called the hedgehog look!

Also, whatever adjunct you have won't improve respiration; it will (hopefully!) improve oxygenation. In the short term sub optimal ventilation can be tolerated provided that the oxygenation is satisfactory. And as a timely remind, oxygenation and ventilation are not the same thing.

Which is why ETCO2 waveform capnography is so beneficial. It can show whether pt is adequately ventilating or needs intervention.