# OPA with overdose?



## sleepy (Apr 26, 2010)

I'm studying for NREMT. This sample question says your patient overdosed on Valium and is unconscious. Their answer is to put him in lateral recumbent position to protect his airway, instead of inserting an OPA which I thought was correct. I know you don't insert OPA when something like drain cleaner was ingested, but you avoid it for pills too? Doesn't make sense to me. Or what is their reason?


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## feldy (Apr 26, 2010)

with an OD, i wouldnt use an OPA, i would go with the NPA because of the high chance that if pt. wakes up then they are gonna vomit and as long as youre not assisting ventilations go with latteral recumbant.


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## mycrofft (Apr 26, 2010)

*Ten points*

Rule of thumb is do the most with the least chance of harm.
Rule of Exam: say what they want and ask on EMTLIFE what they mean.

IF trismus is a potential (not with a benzodiazepine like Valium), then yeah, get an OPA in. Otherwise, suction and ventilation can be a problem.


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## Porkchop (Apr 26, 2010)

feldy said:


> with an OD, i wouldnt use an OPA, i would go with the NPA because of the high chance that if pt. wakes up then they are gonna vomit and as long as youre not assisting ventilations go with latteral recumbant.



+1.  In EMT school, I was taught never to use an OPA with an overdose.


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## BLSBoy (Apr 26, 2010)

Porkchop said:


> +1.  In EMT school, I was taught never to use an OPA with an overdose.



Never say never....


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## mycrofft (Apr 26, 2010)

*We had a mixed OD (Elavil, Neurontin, and whatever else he could get)..*

Wished we could have gotten an OPA in place (we don't have tubes) before trismus set in and he was drooling. Snaked a Yankauer tip in one buccal side and turned him in that side, but it mostly wanted to suck off his buccal mucosa, not the slime.


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## MrBrown (Apr 26, 2010)

If somebody has OD'd on benzos the only thing I wouldn't be using is flumazinil!

Don't see the reason not to use an OPA if they wake up and don't tolerate it take it out, if the throw up, take it out.


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## VentMedic (Apr 26, 2010)

MrBrown said:


> If somebody has OD'd on benzos the only thing I wouldn't be using is flumazinil!
> 
> Don't see the reason not to use an OPA if they wake up and don't tolerate it take it out, if the throw up, take it out.


 
The thing about an OPA, unless you are actively managing that airway, the OPA can become an obstruction. How many times when using a BVM have you had to pause briefly to readjust the OPA?

If they throw up with the OPA in place, they have aspirated. The preferred would be to not cause vomiting until patient and airway are in good position with easy access.


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## MrBrown (Apr 26, 2010)

Couldn't we say the same for anybody who has is unconscious and gets an OPA, they are all at risk of vomiting.


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## VentMedic (Apr 26, 2010)

MrBrown said:


> Couldn't we say the same for anybody who has is unconscious and gets an OPA, they are all at risk of vomiting.


 

If you are using a BVM and have control over the airway, your eyes will be on that patient and you should have suction available. I have seen patients brought in with an OPA and on a NRBM without anybody watching the airway and the mouth full of vomit. If you are using an OPA and/or the BVM, you should have suction nearby, really nearby. Occasionally the patient wakes up somewhere between the ambulance and the ED bed where to get to suction in either direction is a scramble.


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## Shishkabob (Apr 26, 2010)

feldy said:


> with an OD, i wouldnt use an OPA, i would go with the NPA because of the high chance that if pt. wakes up then they are gonna vomit and as long as youre not assisting ventilations go with latteral recumbant.



Waking up has nothing to do with someone vomiting when something is in their mouth.  It has to do with someone having an intact gag reflex.  If they don't have a gag reflex, you're probably good to go.  

You'll often see an OPA used in the OR, and someone will most likely wake up much more quickly from a Propofol dosing than from a Valium overdose.


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## VentMedic (Apr 26, 2010)

Linuss said:


> You'll often see an OPA used in the OR, and someone will most likely wake up much more quickly from a *Propofol* dosing than from a Valium overdose.


 
There is a reason we use Propofol and it is so they do not wake up until we are ready for them to do so.  That would be a disaster on some forms of ventilation and during some procedures. That is why Propofol is the drug of choice.   For the Valium OD, do you know how much the patient took?  You do know the dosing for Propofol.  If the patient is in the OR  they probably have been given a paralytic and are on an ETCO2 monitor to know when there is diaphragm action to indicate the patient is waking.


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## John E (Apr 28, 2010)

*Hmmm...*

was the patient breathing in the scenario?

Lots of people putting the cart before the horse.

John E


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## WallabyWalrus (Nov 28, 2012)

sleepy said:


> I'm studying for NREMT. This sample question says your patient overdosed on Valium and is unconscious. Their answer is to put him in lateral recumbent position to protect his airway, instead of inserting an OPA which I thought was correct. I know you don't insert OPA when something like drain cleaner was ingested, but you avoid it for pills too? Doesn't make sense to me. Or what is their reason?




I don't understand? put a dose of Flumazenil into his vein and watch him wake up instantly and be standing by with another dose of any kind of IV Benzo in case he is dependent upon benzo's. As Flumazenil can cause the patient to start having a seizure if pt is SEVERELY addicted. so on 2nd thought maybe not such a good idea unless you know patients background...

Its kind of like an opiate OD and how narcan effects the patients. If you give an opiate addict a huge IV dose of naloxone he/she will usually wake up and immediately start having withdrawal symptoms. :unsure:


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## STXmedic (Nov 28, 2012)

WallabyWalrus said:


> I don't understand? put a dose of Flumazenil into his vein and watch him wake up instantly and be standing by with another dose of any kind of IV Benzo in case he is dependent upon benzo's. As Flumazenil can cause the patient to start having a seizure if pt is SEVERELY addicted. so on 2nd thought maybe not such a good idea unless you know patients background...
> 
> Its kind of like an opiate OD and how narcan effects the patients. If you give an opiate addict a huge IV dose of naloxone he/she will usually wake up and immediately start having withdrawal symptoms. :unsure:



Holy necro-thread!

You carry flumazenil where you work? Hell, most doctors I know don't even mess with flumazenil anymore. Have fun controlling that seizure with that on board... Why not just ensure adequate oxygenation and cruise in nice and chill to the hospital?


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## TheLocalMedic (Nov 28, 2012)

I'm a big fan of the "more is better" approach to BLS airway management.  Until such time as you are able to get a tube, you will be doing yourself a huge favor and making your ventilations easier by dropping not only an OPA but an NPA in each nostril as well.  What?  Three BLS adjuncts?  That's right, THREE!  Granted, it's a little unconventional, but I think that the logic speaks for itself on this one if you think about it.  

And so you pop in an OPA and the pt starts to gag or vomit?  Just pull it out, roll 'em and suction really well.  Oh, and BAM!  You've still got two NPAs in place to boot!


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## DesertMedic66 (Nov 28, 2012)

TheLocalMedic said:


> I'm a big fan of the "more is better" approach to BLS airway management.  Until such time as you are able to get a tube, you will be doing yourself a huge favor and making your ventilations easier by dropping not only an OPA but an NPA in each nostril as well.  What?  Three BLS adjuncts?  That's right, THREE!  Granted, it's a little unconventional, but I think that the logic speaks for itself on this one if you think about it.
> 
> And so you pop in an OPA and the pt starts to gag or vomit?  Just pull it out, roll 'em and suction really well.  Oh, and BAM!  You've still got two NPAs in place to boot!



I don't really see the need for NPAs plus an OPA. The job of the OPA and NPA are to keep the tongue off the back of the throat. That can and most of the time is easily achieved with just using one of the BLS adjuncts.


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## TheLocalMedic (Nov 28, 2012)

firefite said:


> I don't really see the need for NPAs plus an OPA. The job of the OPA and NPA are to keep the tongue off the back of the throat. That can and most of the time is easily achieved with just using one of the BLS adjuncts.



Yeah, but if you have an issue with one of you adjuncts, you can pull it an still have other adjuncts already in place.  And it really does make ventilation easier.  I recommend you try it a few times so you can see the difference!


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## Achilles (Nov 28, 2012)

If you're getting good ventilationa with out an OPA or npa why even put one in?


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## TheLocalMedic (Nov 28, 2012)

Why get good ventilation when you can have great ventilation?  And having adjuncts really does make a difference and makes suctioning easier.  Again, try it out for yourself!


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## DesertMedic66 (Nov 28, 2012)

TheLocalMedic said:


> Why get good ventilation when you can have great ventilation?  And having adjuncts really does make a difference and makes suctioning *harder*.  Again, try it out for yourself!



There fixed it for you haha. 

If the airway is patent why play with it?


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## NomadicMedic (Nov 28, 2012)

firefite said:


> I don't really see the need for NPAs plus an OPA. The job of the OPA and NPA are to keep the tongue off the back of the throat. That can and most of the time is easily achieved with just using one of the BLS adjuncts.



A matter of preference? If I have a BLS airway that I need to manage, it's pretty common practice here to use both NPAs and an OPA. It really does make life easier. The BLS guys do it without asking in codes.


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## TheLocalMedic (Nov 28, 2012)

n7lxi said:


> A matter of preference? If I have a BLS airway that I need to manage, it's pretty common practice here to use both NPAs and an OPA. It really does make life easier. The BLS guys do it without asking in codes.



As it should be.  I fully expect that when someone is being bagged they get at least one adjunct, and then I ask that they put in at least one more.


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## leoemt (Nov 28, 2012)

sleepy said:


> I'm studying for NREMT. This sample question says your patient overdosed on Valium and is unconscious. Their answer is to put him in lateral recumbent position to protect his airway, instead of inserting an OPA which I thought was correct. I know you don't insert OPA when something like drain cleaner was ingested, but you avoid it for pills too? Doesn't make sense to me. Or what is their reason?



The OPA is not indicated  if they have a Gag reflex. If they have OD'd and their breathing is inadequate then use an OPA and begin ventilations, be prepared to suction. 

Most OD patients are going to vomit anyways whether you use an OPA or not. The OPA is much faster and easier than an NPA. 

Attempt an OPA, if they have a gag or develop one then remove it and use an NPA. 

If there breathing is that bad - what do you think the medics are going to do? Most likely they are going to drop a tube. That is a lot more invasive than an OPA. 

Bottom line - do what you need to do to ensure a patent airway.


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## NomadicMedic (Nov 28, 2012)

In a benzo overdose, depending on how much they've taken, they've already partially performed RSI for me.  I'll be honest, I've only seen one benzo OD that required airway management, and I just dropped an ET tube. She had no gag and I didn't need any paralytics. Most of the time, when I find them, they're just weepy and sleepy. 

I will agree with LEOEMT, if the patient has any gag, but requires a BVM, use an NPA and keep the suction ready. (And I think NPAs are still verboten in King County. It's an OPA or nothing there...)


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## leoemt (Nov 28, 2012)

n7lxi said:


> In a benzo overdose, depending on how much they've taken, they've already partially performed RSI for me.  I'll be honest, I've only seen one benzo OD that required airway management, and I just dropped an ET tube. She had no gag and I didn't need any paralytics. Most of the time, when I find them, they're just weepy and sleepy.
> 
> I will agree with LEOEMT, if the patient has any gag, but requires a BVM, use an NPA and keep the suction ready. (And I think NPAs are still verboten in King County. It's an OPA or nothing there...)



You are correct sir - no NPA's here in King County.


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## DesertMedic66 (Nov 28, 2012)

http://www.emtlife.com/showthread.php?t=16406

This thread pretty much sums up why I've never seen both an OPA and NPA placed together. More specifically the posts made by VentMedic. 

Neither the OPA or NPA takes long at all to place. No gag = OPA. If the patient starts to gag it does not take long at all to take the OPA out and insert an NPA. 

And the same as what everyone has said about having suction really close by.


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## usalsfyre (Nov 28, 2012)

leoemt said:


> You are correct sir - no NPA's here in King County.



:blink:

WHY?!?


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## usalsfyre (Nov 28, 2012)

TheLocalMedic said:


> As it should be.  I fully expect that when someone is being bagged they get at least one adjunct, and then I ask that they put in at least one more.



Negative, placing an adjunct in a patient who needs ventilatory assistance but is doing a decent job protecting their airway is taking unneeded risk.


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## leoemt (Nov 28, 2012)

usalsfyre said:


> :blink:
> 
> WHY?!?



Dunno why. It is BLS at the State level. Why do I get sent to Diabetic emergencies but can't do glucometry when I get on scene - Have to call ALS to do a finger stick for me. 

I would assume that the thinking is something along the lines that airway should be evaluated by ALS.


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## NYMedic828 (Nov 28, 2012)

leoemt said:


> The OPA is not indicated  if they have a Gag reflex. If they have OD'd and their breathing is inadequate then use an OPA and begin ventilations, be prepared to suction.
> 
> Most OD patients are going to vomit anyways whether you use an OPA or not. The OPA is much faster and easier than an NPA.
> 
> ...



Fully agree.

To even get a patient to accept an OPA, they have to be out cold and then some. Odds are if its second to an overdose their respiratory status needs assistance at that point and they probably vomited already or will soon.

The job of an OPA and an NPA is to prevent the soft palate and tongue from obstructing the airway. They DO NOT in any way prevent vomiting which is the primary risk factor (for us EMS folk) of most of our overdosed patients that can't be fixed with some narcan.

It is extremely important to reduce risk of aspiration for that patient should they vomit. Sitting them up or putting them in a recumbent position or a little of both holds great value.


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## TheLocalMedic (Nov 28, 2012)

firefite said:


> http://www.emtlife.com/showthread.php?t=16406
> 
> This thread pretty much sums up why I've never seen both an OPA and NPA placed together. More specifically the posts made by VentMedic.
> 
> ...



I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best.  Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier.  Why conform to a "if a doesn't work try b" approach when you can have a, b and c?


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## Clare (Nov 29, 2012)

TheLocalMedic said:


> Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier



I heard about this a while ago and it was called the "Hedgehog look"; made me laugh.

Nothing wrong per-se with using an OPA in this patient, I would probably use a nasal airway and roll them on their side.


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## Achilles (Nov 29, 2012)

TheLocalMedic said:


> I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best.  Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier.  Why conform to a "if a doesn't work try b" approach when you can have a, b and c?



Why would you spend that much time with airway adjuncts when you could be bagging them.


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## Clare (Nov 29, 2012)

Achilles said:


> Why would you spend that much time with airway adjuncts when you could be bagging them.



Because if you have a patent airway it makes ventilation much easier and means you do not have to sit there giving somebody an active jaw thrust for the entire journey to hospital.


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## DesertMedic66 (Nov 29, 2012)

TheLocalMedic said:


> I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best.  Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier.  Why conform to a "if a doesn't work try b" approach when you can have a, b and c?



Or you can just give the patient a patent airway with an OPA or a NPA and then move on to bagging the patient and moving on with the assessment and treatments. 

Once you get a patent airway is there really a need to make sure it's "super patent" by shoving more things down their oral/naso pharynx?


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## Tigger (Nov 29, 2012)

TheLocalMedic said:


> I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best.  Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier.  Why conform to a "if a doesn't work try b" approach when you can have a, b and c?



How exactly have you determined that this method is more effective? Saying "it's better cause I say so" is worse than arguing the "theoreticals."

Also in the few BLS airways I've had, all required constant positioning of the jaw and head to maintain effective ventilation even with an adjunct.


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## Achilles (Nov 29, 2012)

Clare said:


> Because if you have a patent airway it makes ventilation much easier and means you do not have to sit there giving somebody an active jaw thrust for the entire journey to hospital.



Why not just use a king?


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## TheLocalMedic (Nov 29, 2012)

The "because I say so" bit only comes from having heard about it, tried it, and had it work well.  I did a side by side comparison on several patients, first bagging them with just an OPA or NPA and then with an additional adjunct or two.  There is a noticeable difference.  Granted, positioning is a crucial and often overlooked aspect of ventilation in the prehospital setting, so that's a must as well.


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## TheLocalMedic (Nov 29, 2012)

Achilles said:


> Why not just use a king?



At least where I'm from, the king airway is still under ALS scope, so it makes it a moot point for a BLS airway discussion.


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## Clare (Nov 29, 2012)

Achilles said:


> Why not just use a king?



You could use an LMA but I think that's a bit of overkill for overdose patient with an altered level of consciousness but still spontaneously breathing  

If they are very deeply unconscious and have inadequate breathing then an LMA is appropriate.


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## STXmedic (Nov 29, 2012)

Clare said:


> You could use an LMA but I think that's a bit of overkill for overdose patient with an altered level of consciousness but still spontaneously breathing
> 
> If they are very deeply unconscious and have inadequate breathing then an LMA is appropriate.



Just out of curiosity and fairly irrelevant to the discussion, but I'm assuming you aren't from the US?


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## Clare (Nov 29, 2012)

PoeticInjustice said:


> Just out of curiosity and fairly irrelevant to the discussion, but I'm assuming you aren't from the US?



Your assumption is correct.  Do my words have a foreign sound to them or something? 

The LMA is great for patients who are unconscious and poorly oxygenated +/- spontaneously breathing.  If a patient just has an altered level of consciousness be it from a traumatic brain injury, overdose, poisoning, stroke or whatever and is spontaneously breathing adequately I don't think an LMA is indicated; if they have inadequate oxygenation or are difficult to ventilate with just an oral airway then an LMA will do the trick.


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## Aidey (Nov 29, 2012)

Clare said:


> Your assumption is correct.  Do my words have a foreign sound to them or something?
> .



You've used British English spelling several times.


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## STXmedic (Nov 29, 2012)

Clare said:


> Your assumption is correct.  Do my words have a foreign sound to them or something?
> 
> The LMA is great for patients who are unconscious and poorly oxygenated +/- spontaneously breathing.  If a patient just has an altered level of consciousness be it from a traumatic brain injury, overdose, poisoning, stroke or whatever and is spontaneously breathing adequately I don't think an LMA is indicated; if they have inadequate oxygenation or are difficult to ventilate with just an oral airway then an LMA will do the trick.



In the states we call GTN NTG  Also, most places here do not carry/use LMAs. King tubes are by far the most common BIAD, though I'm sure there are still some combi tubes and LMAs floating around somewhere.

To try and be somewhat on topic:
If the patient has spontaneous, adequate respirations with no airway compromise, of course they don't need a tube (whatever your tube of choice). Maybe an NPA if anything, and let them be.

Once you start having to drop an OPA, hold a jaw thrust and bag them, then they'll probably buy some form of tube. And no, not a moot point on Kings. MANY areas consider a King tube a BLS airway. It is by no means uncommon.

In regards to multiple airway adjuncts, I've seen the "hedgehog" face (?) before, don't think I'm sold on it. If I can get an OPA, awesome. A single NPA along with it is nice if they're likely to get intubated (in case there's a missed tube, they still have an adjunct in). I really don't see the need to drop an OPA and two NPAs, though... Like firefite said, if you can secure a good and patent airway, why do you need a super-duper good one. More is not always more.


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## Clare (Nov 29, 2012)

Aidey said:


> You've used British English spelling several times.



Please excuse me while I fetch tea and crumpets .... 



PoeticInjustice said:


> If the patient has spontaneous, adequate respirations with no airway compromise, of course they don't need a tube (whatever your tube of choice). Maybe an NPA if anything, and let them be.



I agree that an NPA and lateral positioning for a patient who is spontaneously breathing but is unconscious or has an altered level of consciousness is most likely all that is required.  



PoeticInjustice said:


> Once you start having to drop an OPA, hold a jaw thrust and bag them, then they'll probably buy some form of tube. And no, not a moot point on Kings. MANY areas consider a King tube a BLS airway. It is by no means uncommon.



It depends; I think for patients who require a bit more airway intervention but are close to hospital (< 15 min) or who do not have very poor oxygenation then an OPA is appropriate.  For somebody who is in respiratory arrest, very poorly oxygenated or who is more distant from hospital then an LMA is a good idea.

From memory the average number of insertions per year per person is two or three and this seems fairly correct.

The LMA is great, it's cheap and works reasonably well for what it was intended for.  It is an ideal middle point between a supraglottic airway and intubation, it is easy to insert and an easy skill to keep up.  They've been around for a number of years now, first appearing somewhere between 2003 and 2007, and are very much here to stay. There has also been a big push to not intubate people if an LMA is in place, working well and the patient is reasonably close to hospital (< 15 min).  RSI is an exception to this of course.


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## WallabyWalrus (Nov 29, 2012)

But still I don't understand why you guys don't have a a GABA antagonist like Flumazenil or something? That would be the best way to reverse all the symptoms of an OD.. But honestly its really hard to OD on accident on benzo's, so basically if you see someone OD'd on a benzo its most likely a suicide attempt which means they took a ridiculous high dose which would require a GABA antagonist anyways once they arrive at hospital... But yeah I doubt hardly any of you guys have even come across a benzo OD sense its not like barbs which were a lot easier to OD on, but benzo's replaced those way way back in the day (like in the 80's).. :unsure:


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## Achilles (Nov 29, 2012)

It reverses the symptoms?


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## usalsfyre (Nov 29, 2012)

WallabyWalrus said:


> But still I don't understand why you guys don't have a a GABA antagonist like Flumazenil or something? That would be the best way to reverse all the symptoms of an OD..


Except they have a nasty tendency to have status seizure that are refractory to ANY treatment (not just benzos) after Romazicon.                         



WallabyWalrus said:


> But honestly its really hard to OD on accident on benzo's, so basically if you see someone OD'd on a benzo its most likely a suicide attempt which means they took a ridiculous high dose which would require a GABA antagonist anyways once they arrive at hospital... But yeah I doubt hardly any of you guys have even come across a benzo OD sense its not like barbs which were a lot easier to OD on, but benzo's replaced those way way back in the day (like in the 80's).. :unsure:


You very, very rarely see a true benzo overdose due to the fact it has indirect action. Usually its a polypharm/alcohol issue. Which is why its far safer to ventilate/tube them and wait it out than to start reversing stuff.


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## WallabyWalrus (Nov 29, 2012)

^^ Yeah that is very true... you are very right... Oh well I was just thinking of why EMT's don't carry much more meds then they do. Oh well..:wacko:


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## NYMedic828 (Nov 29, 2012)

WallabyWalrus said:


> ^^ Yeah that is very true... you are very right... Oh well I was just thinking of why EMT's don't carry much more meds then they do. Oh well..:wacko:



Because then they would just be a paramedic


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## Achilles (Nov 29, 2012)

NYMedic828 said:


> Because then they would just be a paramedic



Lol I like that.


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## Aidey (Nov 29, 2012)

usalsfyre said:


> Except they have a nasty tendency to have status seizure that are refractory to ANY treatment (not just benzos) after Romazicon.



In all the times I've followed up on my benzo ODs I've never heard of a hospital giving it. Depending on which benzo and how much the patient either gets tubed for a day or two or monitored.


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## abckidsmom (Nov 29, 2012)

Aidey said:


> In all the times I've followed up on my benzo ODs I've never heard of a hospital giving it. Depending on which benzo and how much the patient either gets tubed for a day or two or monitored.



Me too. We have one toxicology attending who loves when they OD on benzos on top of whatever else because then at least they just sleep it off.


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## phideux (Nov 29, 2012)

John E said:


> was the patient breathing in the scenario?
> 
> Lots of people putting the cart before the horse.
> 
> John E



Bingo!!!! Unconscious does not mean not breathing adequately, or an airway that is not patent. No info about the airway status in the Original Post. I'm not in the habit of just dropping in an OPA in an OD.


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## Achilles (Nov 29, 2012)

phideux said:


> Bingo!!!! Unconscious does not mean not breathing adequately, or an airway that is not patent. No info about the airway status in the Original Post. I'm not in the habit of just dropping in an OPA in an OD.


\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/


Achilles said:


> If you're getting good ventilationa with out an OPA or npa why even put one in?


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## lightsandsirens5 (Nov 29, 2012)

Achilles said:


> \/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/\/



V-Tach?


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## Clare (Nov 29, 2012)

lightsandsirens5 said:


> V-Tach?



Looks like VT to me


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## Achilles (Nov 30, 2012)

lightsandsirens5 said:


> V-Tach?


:rofl: I lol'ed :rofl: SVT 


Clare said:


> Looks like VT to me


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## Clare (Nov 30, 2012)

Achilles said:


> :rofl: I lol'ed :rofl: SVT



Needs a shorter QRS duration to be SVT


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## VFlutter (Nov 30, 2012)

Clare said:


> Needs a shorter QRS duration to be SVT



SVT w/ LBBB


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## TheLocalMedic (Nov 30, 2012)

VVVVVVVVV

That's not normal?


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## Aidey (Nov 30, 2012)

Ok, time to get back on topic people.


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