# UPSIDE DOWN! TURN THE OPA OVER!



## Summit (Mar 26, 2005)

Avalanche mission. Very sad. Hours and hours.

A dog finally finds the guy and we dig through the heavy debris. We finally dig the guy up. In the hole are 3 SAR EMTs (including me) and a ski patroller from a nearby resort rapid deployment team (supposed to be an experienced guy). I'm holding up the dead pt and checking for a pulse I know is not there. Another EMT is holding the Pts mouth open for the OPA that has been handed to the ski patrolle. Most ski patrollers start out as OEC (EMT-Lite, outdoor emergency care) and then get their EMT. This guy had to have been an EMT for at least a year if not 3 or 4. He kept on trying to put the OPA in the wrong way. I and another EMT yelled "upside down! turn the OPA over!" a couple of times before the other EMT who wasn't supproting the pt simply grabbed it from the patrollers hands, turned it the way it should, inserted and turned.

The patient was very dead so it didn't matter in the end, but yeesh! You would think someone who has been a medical professional for 3-5 years would know how to put in a friggin OPA!


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## Jon (Mar 26, 2005)

> _Originally posted by Summit_@Mar 26 2005, 02:20 AM
> * Avalanche mission. Very sad. Hours and hours.
> 
> A dog finally finds the guy and we dig through the heavy debris. We finally dig the guy up. In the hole are 3 SAR EMTs (including me) and a ski patroller from a nearby resort rapid deployment team (supposed to be an experienced guy). I'm holding up the dead pt and checking for a pulse I know is not there. Another EMT is holding the Pts mouth open for the OPA that has been handed to the ski patrolle. Most ski patrollers start out as OEC (EMT-Lite, outdoor emergency care) and then get their EMT. This guy had to have been an EMT for at least a year if not 3 or 4. He kept on trying to put the OPA in the wrong way. I and another EMT yelled "upside down! turn the OPA over!" a couple of times before the other EMT who wasn't supproting the pt simply grabbed it from the patrollers hands, turned it the way it should, inserted and turned.
> ...


 Summit - I understand your point, but I'm going to argue for the sake of argument  

PALS teaches to use a tounge blade to assist in airway insertion, and NOT to turn the OPA.

I've heard it said in class that adults are the same way, and that, although the spin of the airway works for some Pt's it doesn't for others.


Jon
(Just trying to make life intresting)


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## Summit (Mar 26, 2005)

Wasn't working with this guy. This patroller hasn't been in a PALS class. He is an EMT-B. There was no tongue blade (I admit I don't know what that is, but he didn't have one).


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## Jon (Mar 26, 2005)

> _Originally posted by Summit_@Mar 26 2005, 01:09 PM
> * There was no tongue blade (I admit I don't know what that is, but he didn't have one). *


 Tounge depressor - big piece of wood, usually found in glass jars in Dr's offices.


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## CodeSurfer (Mar 27, 2005)

We were taught to put it in sideways and twist it into place.  A lot of thr EMT's who helped in our labs told us to put it upside down and twist it in... i like the sideways technique better.


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## Wingnut (Mar 27, 2005)

We were taught upside down but I bet sideways would be easier...I'll have to try it.


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## TTLWHKR (Mar 27, 2005)

Upside down then twist it around into place... or push the tongue down w/ a blade or bite stick.


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## rescuecpt (Mar 27, 2005)

Like anything else, if you don't do it or practice it enough, you're not going to remember how to do it with all of the adrenaline and distraction of an urgent situation.  This guy needs more training/refreshers/etc.


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## ffemt8978 (Mar 28, 2005)

I recently had a patient where I was unable to get an OPA in.  The kid had been ejected from a vehicle travelling at 100+ mph, and his head left a 4 inch divot in the sand where he impacted.  We get on scene, and he's vomiting blood.  I attempt a jaw thrust while waiting for an OPA, but he's clenching down and posturing.  I was unable to get an OPA or open the airway manually, but the flight crew showed up two minutes later and intubated him.

During post run critique, somebody asked why I didn't insert an NPA.  I responded that the kid had massive head injuries and NPA's are contraindicated.  (The kid had the back half of his skull shattered.)

I was always taught to turn it 180 degrees, but I might try the 90 degree turn next time.


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