# Question about my practica..



## Jay506 (Jul 31, 2010)

Hello all, I have a question about a skill on my practical and was hoping you all would be kind enough to offer your opinions.

So the skill was inserting an oral airway, the patient starts to gag, choke and become conscious so we have to suction and then insert a nasal airway....simple enough right?

Well, *I didn't suction the nasal*, just the oral because that's where the airway was inserted at the time of gagging!  So I suctioned the mouth properly I'm sure and asked the instructor if the suction was sufficient, he replied yes so I removed the suction, turned the machine off, measured my nasal airway, lubed it, inserted it(I believe with the bevel toward the septum, but either way that's not a critical fail...I don't think) and that is where I ended the skill.

Do you think I passed or failed?....I'm worried if I should of suctioned the nasal canal as well but like I said, he didn't say anything was wrong with the nasal so I just inserted the airway.

Btw, yes I said BSI and opened the airway with head tilt chin lift after I asked if there was trauma and the instructor said NO.  I did make sure there was a patent airway before initially inserting the oral airway, but I didn't specifically verify a patent airway for the nose just because I figured there was since there was for the oral airway in the beginning.


----------



## emtstudent04 (Jul 31, 2010)

Did you obtain a patent airway with both the OPA and the NPA? As in did you make sure the airway was open before you inserted the airway devices? When you inserted either the OPA or NPA did you do it in a manner that is dangerous to the patient?

It's a critical fail if you don't obtain a patent airway for both airway devices. I see you did with the OPA but you didn't with the NPA thats probably where you failed.


----------



## Jay506 (Jul 31, 2010)

How would you specifically obtain a patent airway for NPA?  When I first approached the patient I made sure there was a patent airway via head tilt chin lift and the instructor said "Yes"...so isn't that a patent airway?  He never stopped me for anything regarding the nose so why would I assume it's not a patent airway?


----------



## MediMike (Jul 31, 2010)

I'm not sure if you were taking the NREMT-Basic practical exam or if you have a state specific practical, but according to the NREMT-Basic Practical Skills Sheets "Suctions oropharynx/nasopharynx" is the skill that needed to be demonstrated.

Only critical fail listed regarding suctioning is:
"Did not demonstrate acceptable suction technique"

I did the same as you many years ago and passed lol

Why did they not tell you if you passed or failed? Is this an end of class practical exam or an in-class section exam?  If its an end of class final exam I believe they are required to let you know if you passed or not so you'd be able to re-test


----------



## MrBrown (Jul 31, 2010)

You said the patient gagged and became conscious, well in that case I wouldn't use a nasal airway.  Why? Because if he is conscious and gagging he doesn't need us to help him maintain his airway.

A little oral suctioning perhaps, and turn him on his side if he's not standing up talking to you.


----------



## MediMike (Aug 1, 2010)

MrBrown said:


> You said the patient gagged and became conscious, well in that case I wouldn't use a nasal airway.  Why? Because if he is conscious and gagging he doesn't need us to help him maintain his airway.
> 
> A little oral suctioning perhaps, and turn him on his side if he's not standing up talking to you.



These scenarios are designed to demonstrate all applicable EMT-Basic skills, so you initially run across an unconsc. unresp. patient, they ask you to put in an oral airway, after ventilating they tell you the patient gags and vomits and request that you suction and insert an NPA at that point, then continue to ventilate.

Just the way they set up the scenario


----------



## Akulahawk (Aug 1, 2010)

MediMike said:


> These scenarios are designed to demonstrate all applicable EMT-Basic skills, so you initially run across an unconsc. unresp. patient, they ask you to put in an oral airway, after ventilating they tell you the patient gags and vomits and request that you suction and insert an NPA at that point, then continue to ventilate.
> 
> Just the way they set up the scenario


Yep. That's pretty much it, and the thinking behind it. After all, the semi-conscious (almost unconscious) patient might yet be able to cough and gag a little, but still need ventilatory support.


----------



## firetender (Aug 1, 2010)

Jay506 said:


> suction and then insert a nasal airway....



You said that was the instruction.

If so, then the instruction did NOT include suction again. Besides the fact you suction _in response to_ junk, there's nothing in what you said to make an assumption that more junk kicked up.

I'm curious if you got the thumbs up or thumbs down. Let us know!


----------



## emtstudent04 (Aug 1, 2010)

Jay506 said:


> How would you specifically obtain a patent airway for NPA?  When I first approached the patient I made sure there was a patent airway via head tilt chin lift and the instructor said "Yes"...so isn't that a patent airway?  He never stopped me for anything regarding the nose so why would I assume it's not a patent airway?



My best guess to obtain a patent airway with an NPA would be to continue the head tilt chin lift prior to insertion and after insertion. I was always told anytime you do something to the airway you must re-asses the airway to make sure it is patent. As in your first observation of the pt's airway to see if it is patent and if you discover that it's not patent as you apply the head tilt chin lift you insert an OPA or NPA to help the pt keep it patent, so after you insert the airway adjunct you must re-asses the airway. I hope that makes sense to you. That is what i was told in class.


----------



## Jay506 (Aug 1, 2010)

Thanks for the help folks, I'll certainly let you know if I passed or not.  And yes, this is the end of our course, but they won't tell us for a few days.


----------

