# Why use an OPA/NPA?



## tsuna51 (Aug 13, 2011)

I know that they are used for unconscious patients without a gag reflex, but it was never explained to me what the actual reason to use them is. They move the tongue and create a patent airway, but doesn't the head tilt-chin lift/jaw thrust do that also? My only guess is that it frees you of having to hold the airway open, is that the reason or is it something else?


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## usalsfyre (Aug 13, 2011)

They do a better job than head tilt/chin lift. Quick note, an NPA can also be used when the patient has a gag reflex.

Head tilt/chin lift is done poorly by most of healthcare, encouraged by Resuce Annie who requires her head to be tilted to appx 45 degrees to work. Modified jaw thrust works better, but is painful for the patient and requires two people on airway if a BVM is being used. The best combo I've found is an NPA and a pillow under the head to ensure sniffing position, along with gentle ventilations.


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## Shishkabob (Aug 13, 2011)

To attempt to maintain a patent airway, much like a jaw-thrust or headtilt/chinlift, but while freeing up a provider (or 2 if done correctly) without resorting to an advanced airway such as ET tube or King.



I much prefer NPAs as they can be used in patients with an intact gag without much worry.  I've used more NPAs than OPAs.


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## thisismikedee (Aug 13, 2011)

I just put both in. In case the patient should suddenly regain a gag reflex I just pull the opa out and I don't have to worry about interrupting patient care to size and insert an NPA. BLS adjuncts are just as good as any ALS adjunct out there


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## usalsfyre (Aug 13, 2011)

thisismikedee said:


> I . BLS adjuncts are just as good as any ALS adjunct out there


Not always. Someone who is good at airway management realizes that sometimes all that's needed is repositioning the patient's head, other times nothing but a scalpel will fix the problem. A one size fits all approach sets you up to fail.


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## WuLabsWuTecH (Aug 14, 2011)

The OPA does in fact free up hands for the bagging.  We had a resp arrest, and I needed both hands for the BMV but when his head wasn't tilted, there was a lot of resistance.  We couldn't get the OPA in b/c of his clenched jaw, and the NPA for whatever reason did not cross our minds until much later, so I ended up having to use my knee to tilt his head while using my hands for the BMV (my partner was on IV/Meds).


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## Hunter (Aug 14, 2011)

WuLabsWuTecH said:


> The OPA does in fact free up hands for the bagging. We had a resp arrest, and I needed both hands for the BMV but when his head wasn't tilted, there was a lot of resistance. We couldn't get the OPA in b/c of his clenched jaw, and the NPA for whatever reason did not cross our minds until much later, so I ended up having to use my knee to tilt his head while using my hands for the BMV (my partner was on IV/Meds).


 
I was taught to just toss in both if possible.


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## Shishkabob (Aug 14, 2011)

To you that are advocating using both at the same time, why?  If you accept the fact that an NPA would work if/when you take the OPA out, why not just put the NPA in alone in the first place?


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## Hunter (Aug 14, 2011)

Linuss said:


> To you that are advocating using both at the same  time, why?  If you accept the fact that an NPA would work if/when you  take the OPA out, why not just put the NPA in alone in the first  place?



To me its simply that using both gives you a bigger airway to  deliver more tidal volume over less time. Using and NPA alone may still  leave the tongue to obstruct the oral cavity when you toss in an OPA  with the NPA it gives you two holes for the air to flow through. Only  thing I can compare it to open cric vs needle cric


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## usalsfyre (Aug 14, 2011)

Hunter said:


> To me its simply that using both gives you a bigger airway to  deliver more tidal volume over less time. Using and NPA alone may still  leave the tongue to obstruct the oral cavity when you toss in an OPA  with the NPA it gives you two holes for the air to flow through. Only  thing I can compare it to open cric vs needle cric



An NPA terminates in the hypopharynx, the same place an OPA terminates. They are both designed to hold the tounge off the posterior hypopharynx. Neither one creates an opening the other doesn't.

Plus, big tidal volumes quickly is a surefire route to gastric insufaltion.


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## Hunter (Aug 14, 2011)

usalsfyre said:


> An NPA terminates in the hypopharynx, the same place an OPA terminates. They are both designed to hold the tounge off the posterior hypopharynx. Neither one creates an opening the other doesn't.



When I say that they creat a bigger hole I'm referring to the portion airway aterior to the pharynx, the OPA keeps the tongue out of the way creating a good open pathway through the Oral cavity, and the NPA keeps mucus or other things from creating resistance in the Nasal cavity.



usalsfyre said:


> Plus, big tidal volumes quickly is a surefire route to gastric insufaltion.



Well since we are talking about the most basic of airways you would get gastric distention, however I'm not talking about actually delivering more Tidal volume, but I guess the better way to say it is that it would help to keep a more compliant airway.


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## usalsfyre (Aug 14, 2011)

Hunter said:


> When I say that they creat a bigger hole I'm referring to the portion airway aterior to the pharynx, the OPA keeps the tongue out of the way creating a good open pathway through the Oral cavity, and the NPA keeps mucus or other things from creating resistance in the Nasal cavity.


The area where your keeping the tongue out of the way is the same. The actual oral and nasal cavities you can see aren't the problem. It's the tongue falling back and closing off the portion of the airway superior to the trachea. See if you can find a diagram of where the tip of the airways actually terminate.   



Hunter said:


> Well since we are talking about the most basic of airways you would get gastric distention, however I'm not talking about actually delivering more Tidal volume, but I guess the better way to say it is that it would help to keep a more compliant airway.


I think I get what your saying, but don't ever consign your self to gastric insuflation just because you don't have an advanced airway. With good, gentle technique it can be kept to a very small minimum.


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## Shishkabob (Aug 14, 2011)

Gastric insuflation smastic insuflation.  They just get an NG/OG tube and be done with it.


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## usafmedic45 (Aug 14, 2011)

> To me its simply that using both gives you a bigger airway to deliver more tidal volume over less time.



Son, that's one of those reasons why we joke that one of the differential diagnoses for the cause of pneumothorax is overzealous EMTs named Bubba. 



> Well since we are talking about the most basic of airways you would get gastric distention, however I'm not talking about actually delivering more Tidal volume, but I guess the better way to say it is that it would help to keep a more compliant airway.



There's not going to be that much effect.  I think you should go read up on pulmonary compliance and what exactly effects it.  



> I think I get what your saying, but don't ever consign your self to gastric insuflation just because you don't have an advanced airway. With good, gentle technique it can be kept to a very small minimum.



Exactly.  There is no good reason to be bagging faster than 10-12 breaths a minute in most adult patients.  Any faster and you're risking negative outcome effects due to gastric insufflation, the effects on the cerebral vasculature, pulmonary barotrauma and even hypotension in a hypovolemic or otherwise shocky patient.


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