Use of NPA on ALOC patient?

[NomadicMedic]

Standard approach for ETOH patients. NPA x 2 + OPA. Patent the **** out of that airway!

PLEASE tell me you're kidding.

 

[Carlos Danger]

Can you elaborate?

Very often in moderately sedated patients there is some level of upper airway obstruction in the supine position. They may not tolerate an OPA or even an NPA without adding additional sedation. In those cases, a soft NPA inserted gently along the curvature of the tongue will often work nicely. There's more than one hole you can stick that thing in.

Probably not all that applicable to the prehospital setting, but maybe.

 

[CALEMT]

There's more that one hole you can stick that thing in.

Giggity.

 

[exodus]

Very often in moderately sedated patients there is some level of upper airway obstruction in the supine position. They may not tolerate an OPA or even an NPA without adding additional sedation. In those cases, a soft NPA inserted gently along the curvature of the tongue will often work nicely. There's more than one hole you can stick that thing in.

Probably not all that applicable to the prehospital setting, but maybe.

C-Collars work good as well to keep the airway anatomical. How do you secure the NPA?

 

[Carlos Danger]

C-Collars work good as well to keep the airway anatomical. How do you secure the NPA?

C-collars tend to worsen passive airway obstruction, IME.

No securing needed. They stay put.

 

[Tigger]

If the patient can lift their hand and pull out/block the NPA, that's a pretty good sign that they don't need it yet. Did you try bagging without it?

If the patient needs to be bagged, how will an NPA be a negative?

 

[Underoath87]

If the patient needs to be bagged, how will an NPA be a negative?

My point was that the pt probably didn't need to be bagged in the first place if they still had the ability to fight off the NPA.
And if they're still responsive to pain, try bagging them first without an airway adjunct (since having a foreign object shoved up one's nose hurts like hell).

 

[Tigger]

My point was that the pt probably didn't need to be bagged in the first place if they still had the ability to fight off the NPA.
And if they're still responsive to pain, try bagging them first without an airway adjunct (since having a foreign object shoved up one's nose hurts like hell).

Certainly possible, but I still maintain that using a BVM is hard enough, help yourself and use an adjunct or three.

 

[OCemt86]

What were the patients vitals? Did you have reason to believe the airway would become compromised?

What county in CA were you in? What's the protocol.

Here in California, pretty much anything aside from taking vitals, they're going to want you to upgrade to ALS if you're not already.

Kern county is about the only county with an actual expanded not "expanded" scope of practice, that let's the EMT utilize stuff you were taught how to do. Most other counties it's pretty much, "oh you took a dstick on patient? Upgrade."

Knowing most county EMSA in CA though, if you're going to use an airway adjunct as an EMT without a medic present asking you to do it for them, the patient pretty much has to be a gcs of 3.