# OPA vs NPA



## Cody1911 (May 5, 2013)

Hey! Do either of you prefer one over the other? I know they are each used in different circumstances... but I don't think I have ever seen an OPA used on a PT before. Probably because they weren't fully clonked out and it may have caused a gag reflex. NPA's just seem so much easier. Have you used both? Are they both pretty easy to insert? I've seen many NPA's inserted and it looks like cake. I know with the OPA you have to twist it 180 degrees and such. Do you prefer one over the other? How do you decide which airway to use?


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## DesertMedic66 (May 5, 2013)

Most patients who you can use an OPA on get intubated. They are both easy it place. 

Some members on here place both OPA and NPAs in patients and others will just use one or the other. If there is a gag I use NPA. If there is no gag then it's usually OPA followed shortly by king airway or intubation (assuming the patients airway is not patent and the patient is unconscious).


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## Cody1911 (May 5, 2013)

DesertEMT66 said:


> Most patients who you can use an OPA on get intubated. They are both easy it place.
> 
> Some members on here place both OPA and NPAs in patients and others will just use one or the other. If there is a gag I use NPA. If there is no gag then it's usually OPA followed shortly by king airway or intubation (assuming the patients airway is not patent and the patient is unconscious).



Gotcha! I kind of figured. Again, there is a chapter in my book on intubation but it says to follow your agencies protocols if you can even assist with them. I know with the fire dept here intubation is an ALS thing. So I was kind of shocked seeing it in my book.


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## Summit (May 5, 2013)

What Desert said...

FWIW I think NPAs are underutilized.


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## Trailrider (May 5, 2013)

OPA is great for unconscious bariatric patients, where as ETT isn't not very efficient.  You use what is available to you at any given time,but stay in your scope of practice. ETT isn't the be all end all of everything.


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## Handsome Robb (May 5, 2013)

I've watched plenty of NPAs stimulate a gag reflex but I've also watched plenty of them work flawlessly. 

They both are useful and work like they're supposed to if they're used when they're indicated and easily inserted. I wouldn't say I prefer one or the other. 

Intubation can be a one person thing but its much easier with a helper. It's not uncommon to need someone to hold back upwards and rightwards (BURP) or hold a position after external laryngeal manipulation (ELM) That's why your book talks about assisting rather than performing. There's a lot more to intubating than "Stick the bade in their mouth, lift up and put the tube in the hole."


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## Carlos Danger (May 5, 2013)

An NPA shouldn't stimulate a gag reflex. It can stimulate coughing or sneezing, but that is not the same as a gag reflex. 

You can place both in the same patient. Heck, you can place 2 NPA's and an OPA, for that matter.

I think both devices are under-utilized.


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## Handsome Robb (May 5, 2013)

Halothane said:


> An NPA shouldn't stimulate a gag reflex. It can stimulate coughing or sneezing, but that is not the same as a gag reflex.
> 
> You can place both in the same patient. Heck, you can place 2 NPA's and an OPA, for that matter.
> 
> I think both devices are under-utilized.



I agree they shouldn't, but like I said I've watched it happen many times, to the point of vomiting not just coughing and sneezing.


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## xrsm002 (May 5, 2013)

I saw NPAs used more then
OPAs during my rideouts


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## NomadicMedic (May 5, 2013)

I tend to grab an OPA for codes and an NPA for everything else.


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## Trailrider (May 5, 2013)

xrsm002 said:


> I saw NPAs used more then
> OPAs during my rideouts




I have performed NPAs on manikins in class, but I have never seen the procedure done on car either metro or rural services.  It's just one of those handy little things to know may the need arise.


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## chaz90 (May 5, 2013)

I put NPAs in frequently. They're very useful, and quite well tolerated most of the time. For me, an OPA is typically a hold-over to intubation. Either I'm using it while ventilating with a BVM on a cardiac arrest or it's a sign that my patient probably doesn't have a gag reflex that will prevent airway control without drugs. I imagine an OPA could be used on a subset of opiate OD patients too that you're ventilating, but I haven't had one of those in forever.


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## Bullets (May 5, 2013)

Summit said:


> What Desert said...
> 
> FWIW I think NPAs are underutilized.



You guys need to ride with me sometime. I use NPAs pretty much exclusively. 

Most of my unconscious patients have had gag reflex. I dont even waste my time with the OPA if they are unconscious, go straight to the NPA.


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## usalsfyre (May 5, 2013)

Trailrider said:


> OPA is great for unconscious bariatric patients, where as ETT isn't not very efficient.



Huh?


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## Household6 (May 5, 2013)

Trailrider said:


> I have performed NPAs on manikins in class, but I have never seen the procedure done on car either metro or rural services.  It's just one of those handy little things to know may the need arise.



Try to insert a NPA on yourself.. JMO, but if you can successfully do it on yourself first, it gives you a little more confidence when you do it for the first time on a pt.. 

And it makes for a fantastic FB video... And bragging rights..


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## Bullets (May 5, 2013)

usalsfyre said:


> Huh?



fat tongue and upper airway, lack of neck


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## chaz90 (May 5, 2013)

Bullets said:


> fat tongue and upper airway, lack of neck



Fat people can be super easy tubes, or it can go the other direction and be a nightmare. Same goes for skinny people honestly. This doesn't affect the "efficiency" of an ETT. In large patients, it's more likely you will need a tube to adequately ventilate the patient due to the problems you mentioned and the weight of the chest. Creating a tight enough seal with a BVM on an obese patient can be a disaster, making ventilations difficult with or without an OPA.


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## Bosco836 (May 8, 2013)

Cody1911 said:


> Hey! Do either of you prefer one over the other? I know they are each used in different circumstances... but I don't think I have ever seen an OPA used on a PT before. Probably because they weren't fully clonked out and it may have caused a gag reflex. NPA's just seem so much easier. Have you used both? Are they both pretty easy to insert? I've seen many NPA's inserted and it looks like cake. I know with the OPA you have to twist it 180 degrees and such. Do you prefer one over the other? How do you decide which airway to use?



Although I've used both airways many times, my preference for most patients is the NPA as there is far less risk of stimulating the gag-reflex.  Unless the person is VSA or presents with conditions that contraindicate the use of an NPA, the NPA is my front line BLS airway (for patients requiring airway management). 

As far as ease of insertion, I find the OPAs slightly easier to insert - even if you have to rotate them.  The problem with some patients is that their nasal passage may be partially occluded, and as such, an NPA may be difficult to pass.  That being said, I don't find this to be a huge issue on the vast majority of calls where I've had to insert an NPA.


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## Christopher (May 8, 2013)

Trailrider said:


> I have performed NPAs on manikins in class, but I have never seen the procedure done on car either metro or rural services.  It's just one of those handy little things to know may the need arise.



Bizarre, OPA's are the least used of the adjuncts by far in our area (urban, suburban, and rural).

I quite frequently double up on NPA's when I place them. Only once have I got with the three-fer OPA+NPAx2, but they needed some serious oropharyngeal soft tissue splinting.


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## Brandon O (May 9, 2013)

NPAs are like, oh... thank-you cards.

You maybe never "need" them but if you look for chances to use 'em, they're everywhere.


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## Ace 227 (May 9, 2013)

I think I'm one of the only people in my service who has used an NPA in the past year. And I've used several. What I was taught in the Army is that if they might need it, give it. If they decide they don't want it, they'll take it out themselves. If they can't remove it, they probably needed it...


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## Akulahawk (May 9, 2013)

While I know how to use an NPA, I've only ever had to use one a few times. It's just that most of my patients were able to demonstratably keep their airway patent, or they were so far down that they took an OPA... which makes me start reaching for the ETT. I look at airway patency first, then if unable to maintain their airway, I reach for the OPA. If the patient tolerates it, I seriously consider ETT. If not and the patient still can't keep a patent airway, I'll reach for the NPA. If the airway patency is marginal and I don't think they'll take an OPA, then I'll go for the NPA first.


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## DavidM (May 13, 2013)

I use NPAs pretty frequently. I go for them first over OPAs because in my experience they are super quick to place and hard to dislodge accidentally. In fact if I'm worried about the airway I'll just pop 2 in. They're great pre ETT as well because they won't get in the way and will keep the airway patent throughout.


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