# Npa+nrb?



## Foxbat (Feb 6, 2010)

I was taking to a medic I work with about a certain call and we ended up discussing use of airways. Medic's opinion was that if the patient is bad enough to use NPA or OPA on him, you should also ventilate him with BVM, and that putting him on NRB would not make sense.
I'm not sure about it. I've seen medics using airway adjuncts with NRB on a patient who was breathing spontaneously but had snoring respirations.
What do you think?


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## Shishkabob (Feb 6, 2010)

If they're unconscious, but breathing, then yes you can do an NPA and a NRB and would be a prime example of when to do one.


Just because you have an NPA in doesn't mean they aren't doing adequate ventilations.  OPAs and NPAs just help maintain a patent supraglottic airway.


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## VentMedic (Feb 6, 2010)

An NPA can be used on a spontaneously breathing patient provided there is good air exchange.  We also use it for easy access to nasotracheally suction the patient.

If the patient tolerates an OPA, they may not be able to maintain their airway effectively or at least not much longer.  Monitor their breathing and be prepared to take over by BVM.   Some may do okay for awhile but they will probably aspirate whatever oral secretions are in their mouth since the OPA impedes swallowing.  That will also bring about more pulmonary problems if not dealt with.  Always have a suction device ready when using the OPA.


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## MrBrown (Feb 6, 2010)

An NRB is fine, oxygenation and ventilation are not the same thing.


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## lightsandsirens5 (Feb 6, 2010)

+1 on Vent's post.

I have used an OPA with an NRB twice I think. But both times I ended up bagging the pt by the time we reached the ER.

So, yes, I suppose it is perfectly acceptable, just constantly monitor airway, breathing and sats. Definatly an "unstable" (per se) pt. So keep a close eye.


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## mycrofft (Feb 7, 2010)

*Ruless of Thumb.*

Watch the pt. Treat each properly.
Yeah, with response time etc. generally an embarassed airway will need both by the time you see them. Obtunded pt who goes into snore mode when you supinate them on your cot might use O2 and an airway, or CPAP. 

A pt NOT needing ventilatory assist (bagging) will not usually let you administer an airway.


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## dmiracco (Feb 7, 2010)

I have utilized NRB and a NPA countless times.


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## VentMedic (Feb 7, 2010)

dmiracco said:


> I have utilized NRB and a NPA countless times.


 
Hopefully all patients were spontaneously breathing and with adequate air exchange. Unfortunately some forget to keep reassessing breath sounds, rate and quality after they "fixed" the snoring noise.  The mask on the face also sometimes makes it an "out of sight, out of mind" situation.


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## redcrossemt (Feb 14, 2010)

Had a status epilepticus pt yesterday that kept breathing very well despite my attempts to stop her respiratory drive with valium. Placed an NPA and a NRBM. I do it once in a while with good results. Just remember, as stated above, the difference between a patent airway and good air exchange; and to monitor your patient closely.


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## MrBrown (Feb 14, 2010)

redcrossemt said:


> Had a status epilepticus pt yesterday that kept breathing very well despite my attempts to stop her respiratory drive with valium. Placed an NPA and a NRBM. I do it once in a while with good results. Just remember, as stated above, the difference between a patent airway and good air exchange; and to monitor your patient closely.



I know you probably wanted to intubate the patient but stop messing with thier respiratory drive  (/sarchasm)

If the patient is breathing adequately (ie adq ventilation) I don't see a problem with using a NRB and if required a simple adjunct (even a good ole head tilt chin lift if thats what it takes) rather than getting all fancy


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## fortsmithman (Feb 14, 2010)

My service only uses the OPA even though use of the NPA is authorized in our protocols.


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## MrBrown (Feb 14, 2010)

fortsmithman said:


> My service only uses the OPA even though use of the NPA is authorized in our protocols.



Hmm why is that?


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## fortsmithman (Feb 17, 2010)

MrBrown said:


> Hmm why is that?



I think when command was doing the protocols they decided to put everything under the kitchen sink in so to speak.  We do have a couple of member who have used NPA's, but the majority of my service have only used OPA's.  We have a new set of protocols that have to be approved by our medical director and town council.


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## VentMedic (Feb 17, 2010)

fortsmithman said:


> I think when command was doing the protocols they decided to put everything under the kitchen sink in so to speak. We do have a couple of member who have used NPA's, but the majority of my service have only used OPA's. We have a new set of protocols that have to be approved by our medical director and town council.


 
Is it really about personal preference or the condition of the patient?

If the patient has a gag reflex, an OPA would not be appropriate.


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## feldy (Feb 17, 2010)

VentMedic said:


> Is it really about personal preference or the condition of the patient?
> 
> If the patient has a gag reflex, an OPA would not be appropriate.



Im with ventmedic on this, Anytime where the pt has a gag reflex or if they are intoxicated or poisoned (which would cause vomitting) then NPA all the way. that way you dont have to worry about them regaining a gag reflex all of the sudden and possible compromise their own airway (again).


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## hreeves877 (Feb 20, 2010)

The service I work for services a lot of less than impecable people.  I use NPA and NRB combo all the time.  9 times out of 10, it is used on the drunk who is unconscious but breathing well on their own.  Another good use for the NPA is to determine just how "unresponsive" a patient is    Most people who want to play possum for whatever reason will wake up very quickly for two things: an NPA or the mention of a large bill for our services (or in my case, the services of the local MedEvac services)


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