OPA Use

[jwk]

I never said it was the definition of EBM. I said it was an aspect of it. For example, in sports medicine the use of cryotherapy as a treatment modality for acute injuries is considered "inconclusive" by the NATA because of lack of sufficient evidence supporting the therapeutic and physiological effects. However, because it is not shown to have negative effect in those who lack specific cold-related conditions, we still do it anyway. All. The. Time.

I won't say for certain because I haven't been through pharmacology nor done additional research, but I believe I have seen on this forum the argument of epinephrine perhaps not being the most efficient vasopressor in cardiac arrest. We still push it though.

Another analogy. Spine boards require a bear minimum of 3 body straps. Let's say an airway requires 1 adjunct. Whats wrong with me placing 4, 5, 6 straps? What about a 2nd and 3rd adjunct? At no point in either case am I going out of my scope, voiding manufacturer instructions, or committing a tort. If anything, it will improve patient outcome.

I don't think anyone is necessarily arguing that having all 3 adjuncts on board instead of 1 is more effective, but it certainly won't be a negative thing, so why not?

So one is good, two must be better, three even better, since you don't think there's a reason not to do it? That's your idea of "evidence based medicine"?

 

[Carlos Danger]

For example, in sports medicine the use of cryotherapy as a treatment modality for acute injuries is considered "inconclusive" by the NATA because of lack of sufficient evidence supporting the therapeutic and physiological effects. However, because it is not shown to have negative effect in those who lack specific cold-related conditions, we still do it anyway. All. The. Time.

I won't say for certain because I haven't been through pharmacology nor done additional research, but I believe I have seen on this forum the argument of epinephrine perhaps not being the most efficient vasopressor in cardiac arrest. We still push it though.

Another analogy. Spine boards require a bear minimum of 3 body straps. Let's say an airway requires 1 adjunct. Whats wrong with me placing 4, 5, 6 straps? What about a 2nd and 3rd adjunct? At no point in either case am I going out of my scope, voiding manufacturer instructions, or committing a tort. If anything, it will improve patient outcome.

First of all, I don't think pointing to other evidence-less practices is a good strategy for justifying a given evidence-less practice.

Secondly, you have to understand that there is no such thing as a risk-free medical intervention.

Do you always place 2 IV's in every patient? 3 IV's? a 12-lead? Why not?

Placing an airway adjunct is not a benign procedure. Do you know for sure that patient you want to put a second NPA in has no coagulopathy? That they aren't on anticoagulants? Is there really no chance at all that the OPA will stimulate a vagal response, or vomiting?

Airway trumps all. If for some reason you NEED 2 or 3 adjuncts to ventilate, so be it.

But if you are ventilating just fine on just an OPA, or on just 1 NPA, then you really should leave it alone.

 

[Tigger]

I guess my current question is how much do adjuncts help if you are not actively ventilating someone but rather slapping a mask on them and leaving them alone?

 

[Carlos Danger]

I guess my current question is how much do adjuncts help if you are not actively ventilating someone but rather slapping a mask on them and leaving them alone?

Potentially a lot, it just depends on the patient and how obtunded they are. Many people suffer some degree of airway obstruction when relaxed, in some cases a very high degree of obstruction. Usually good head positioning will alleviate it, but that requires constant maintenance.....and even in that case an adjunct will often make it easier.

Chest wall movement in a breathing patient doesn't necessarily mean they are exchanging air well....can you see fogging inside the 02 mask? Can you feel air movement if you place your hand an inch or so from their mouth and nose? Do you have an Etc02 waveform? If yes to all of those, you probably don't need an adjunct. But personally I think a good rule of thumb whenever you are concerned about your patient's ventilatory status is to always use an OPA or NPA if they will tolerate it.

 

[triemal04]

So one is good, two must be better, three even better, since you don't think there's a reason not to do it? That's your idea of "evidence based medicine"?

For a lot of people that's probably not far off. It's a lot easier to do something because "it won't be a negative thing, so why not" rather than consider why you are doing something and what effect, if any, it will have, both immedietly, and down the road.

I guess my current question is how much do adjuncts help if you are not actively ventilating someone but rather slapping a mask on them and leaving them alone?

Probably helps a bit; if this is during a CPR (or CCR I suppose) an OPA would ensure that the tongue doesn't block anything, but then I don't know how much it would matter with the passive flow of O2. I think using 3 is overkill and I can't imagine there would be any benefit over just using an OPA; add in someone adjusting the head and really don't think it'd help.

 

[Carlos Danger]

For a lot of people that's probably not far off. It's a lot easier to do something because "it won't be a negative thing, so why not" rather than consider why you are doing something and what effect, if any, it will have, both immedietly, and down the road.

Probably helps a bit; if this is during a CPR (or CCR I suppose) an OPA would ensure that the tongue doesn't block anything, but then I don't know how much it would matter with the passive flow of O2. I think using 3 is overkill and I can't imagine there would be any benefit over just using an OPA; add in someone adjusting the head and really don't think it'd help.

In passive oxygenation, relief of obstruction matters just as much as with positive pressure ventilation, possibly more.