# OPA insertion



## Foxbat (Dec 22, 2008)

In my EMT class (about a year ago) we were taught to insert an OPA rotated 180 degrees, guide it in, and after feeling resistance, rotate it into correct orientation. I have heard that the guidelines recently changed and OPA has to be inserted at 90 degrees angle.
Who changed it? AHA, ARC? What were the reasons for changing it? Any changes on OPA insertion for pediatric patients?


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## Ridryder911 (Dec 22, 2008)

Two methods are recommended. Insert upside down until the back of the pharyngeal and then rotated into place (180 degrees). The other method is follow the natural curvature while holding the tongue in place. 

R/r 911


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## daedalus (Dec 22, 2008)

It should be noted that the latter technique described by rid/ryder requires the use of a tongue depressor.


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## tydek07 (Dec 22, 2008)

daedalus is correct, the technique R/r describe does require a tongue depressor.

As for the 180 or 90 degree angle, I have seen it taught both ways. When I got my Basic training I was told to use the 180 degree way, and then when I went elsewhere to get my medic one person said use the 180 and another said 90. So, I think it depends on the instructor and which method they like.

I personally like using a toungue depressor when one is available... but as long as it gets in and does the job, I guess I could care less which technique I use.

Take Care,


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## FF894 (Dec 22, 2008)

I think its instructor preference?  By the book I think its still 180 though, but 90-180 doesnt make all that much difference.  The point is to get under/behind the tongue, as long as you can do that you are good. 

I never thought much of the tongue depressor because I had learned the 180 degree turn method all those years ago and thats just how I had always done it.  Then I used the tongue depressor method because the pt had an unusually large tongue/high mallampati and it is much easier.  Also, allows you to better evaluate the airway in case you plan on intubating next, and not that the 180 degree method causes "damage" but it does feel less smooth than the tongue depressor.


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## Ridryder911 (Dec 22, 2008)

The reason most are taught 90 -180 is because the instructor probably does not know the difference. Sorry, it has to be 180 or the OPA would be inserted sideways. 

Sorry about not mentioning the tongue blade. Personally, I carry a couple of them one on me all the time. I

R/r 911


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## Foxbat (Dec 22, 2008)

Thanks to everybody for responses.
If I remember correctly, the only method for pediatric pts. is with tongue depressor. Right?


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## IcantThinkofAname (Dec 22, 2008)

> If I remember correctly, the only method for pediatric pts. is with tongue depressor. Right?



We were taught for peds to insert the OPA as it would lay in the airway, i.e. don't insert it 180 degrees and then rotate, but insert it in the position of function.


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## Skirts (Dec 22, 2008)

IcantThinkofAname said:


> We were taught for peds to insert the OPA as it would lay in the airway, i.e. don't insert it 180 degrees and then rotate, but insert it in the position of function.



So was I, because childrens plalets are softer than adult and you can actually damage it with the OPA if you insert at 180 degrees.  Or at least that's what I was taught.


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## theaussie (Jan 5, 2009)

The biggest difference is the insertion of an OPA into a Paeds pt. It is done with a tongue depressor & nil rotation to avoid insult to the soft palatte. This can also be done in adults, but is not effective.


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## jochi1543 (Jan 10, 2009)

Never even heard of the 90 degree thing. We were taught 180, then turn for adults, and direct w/ tongue depressor for peds.


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## mikeylikesit (Jan 12, 2009)

i go 180 unless there is severe facial damage then i use a depressor. on children i always use a blade.


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## WFDJustin (Jan 29, 2009)

go by the textbook. 180 degrees.


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