# NPA or OPA



## Tuesday (Feb 3, 2011)

Sooo, quick question...

Would you use an NPA or an OPA on an unresponsive trauma patient if you think there may have been an injury to the spine?
Does it really matter which you use in this scenario?


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## lampnyter (Feb 3, 2011)

I would go with OPA if there is suspected head injury


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## Tuesday (Feb 3, 2011)

lampnyter said:


> I would go with OPA if there is suspected head injury



Thank you!
That's what I thought, but then I wasn't sure if inserting an OPA would make the injury worse.


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## JPINFV (Feb 3, 2011)

unresponsive!=lack of gag reflex?


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## lampnyter (Feb 3, 2011)

JPINFV said:


> unresponsive!=lack of gag reflex?



most of the time


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## fast65 (Feb 4, 2011)

If they're unresponsive then go with the OPA, if they don't accept (i.e. intact gag reflex) go with an NPA.


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## Sam Adams (Feb 4, 2011)

fast65 said:


> If they're unresponsive then go with the OPA, if they don't accept (i.e. intact gag reflex) go with an NPA.



+ one


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## MrBrown (Feb 4, 2011)

lampnyter said:


> I would go with OPA if there is suspected head injury



Risk of nasal airway use and head injury is significantly overstated, just be careful, if significant resistance is encountered then stop and try the other nostril.


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## medicdan (Feb 4, 2011)

Are we answering test questions for you?


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## JJR512 (Feb 4, 2011)

emt.dan said:


> Are we answering test questions for you?



If he's actually taking a test right at this moment he shouldn't be able to access the internet to ask for help.

If he's not actually taking a test right at this moment then what difference does it make? Probably most of the questions that get asked here could potentially be test questions to somebody somewhere sometime.

And if you would refuse to answer a question if you suspect it's a test question, then all someone needs to do is answer "NO" if you ask if it's a test question, and I guess that makes everything better.


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## JPINFV (Feb 4, 2011)

JJR512 said:


> If he's not actually taking a test right at this moment then what difference does it make? Probably most of the questions that get asked here could potentially be test questions to somebody somewhere sometime.
> 
> And if you would refuse to answer a question if you suspect it's a test question, then all someone needs to do is answer "NO" if you ask if it's a test question, and I guess that makes everything better.



The problem is that a lot of EMS training is pitifully bad. For example, failing to administer supplemental oxygen via NRB during the NREMT medical patient assessment station is a critical failure. Hence, the proper exam answer is, "Everyone gets oxygen." However, "everyone gets oxygen" is not good for routine treatment.


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## JJR512 (Feb 4, 2011)

JPINFV said:


> The problem is that a lot of EMS training is pitifully bad. For example, failing to administer supplemental oxygen via NRB during the NREMT medical patient assessment station is a critical failure. Hence, the proper exam answer is, "Everyone gets oxygen." However, "everyone gets oxygen" is not good for routine treatment.



I see your point. If the purpose of asking if this was a test question was to ascertain whether a non-real-world answer is appropriate instead of an actual-real-world answer, then I apologize.


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## Melclin (Feb 4, 2011)

MrBrown said:


> Risk of nasal airway use and head injury is significantly overstated, just be careful, if significant resistance is encountered then stop and try the other nostril.



I agree. One of my lecturers was absolutely adamant that he'd never been able to find any evidence of an NPA braining someone with a basal skull fracture.

I've never looked myself, but I feel inclined to trust him.

Not having a patent airway: 100% fatal.
Risk of having a basal skull fracture which then allows the NPA to make its way into brain territory: <100%

I know which one I'd chose.


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## JJR512 (Feb 5, 2011)

Melclin said:


> I agree. One of my lecturers was absolutely adamant that he'd never been able to find any evidence of an NPA braining someone with a basal skull fracture.
> 
> I've never looked myself, but I feel inclined to trust him.
> 
> ...



My instructor claims that he knows of a nurse that killed a patient doing this, if I remember correctly. Even so, we were still taught that head or face trauma does not necessarily contraindicate an NPA.


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## fast65 (Feb 5, 2011)

JPINFV said:


> The problem is that a lot of EMS training is pitifully bad. For example, failing to administer supplemental oxygen via NRB during the NREMT medical patient assessment station is a critical failure. Hence, the proper exam answer is, "Everyone gets oxygen." However, "everyone gets oxygen" is not good for routine treatment.



Agreed, it's like that discussion a couple weeks ago where we tell Basics to ALWAYS dispatch ALS, when in fact we should be teaching them to do a very thorough assessment and really think about whether or not that call needs an ALS unit...but that's another discussion completely.


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## bluefinmedic (Feb 14, 2011)

always OPA unless a suspected skull fractuce. OPA is a vital piece of equipment to be able to secure the airway and not allow the tongue to occlude it.


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## lampnyter (Feb 14, 2011)

bluefinmedic said:


> always OPA unless a suspected skull fractuce. OPA is a vital piece of equipment to be able to secure the airway and not allow the tongue to occlude it.



Umm... No.


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## Anjel (Feb 14, 2011)

lampnyter said:


> Umm... No.



haha agreed. No. If my patient is unresponsive. And has snoring respirations then yes OPA all the way. I don't think you should rely on it all the time though. It's just an adjunct not a cure all. 

And if I suspect a skull fracture or other facial trauma I'm not gonna use an NPA. Just in case. 
*
On another note...*



fast65 said:


> Agreed, it's like that discussion a couple weeks ago where we tell Basics to ALWAYS dispatch ALS, when in fact we should be teaching them to do a very thorough assessment and really think about whether or not that call needs an ALS unit...but that's another discussion completely.



I completely agree with this. I just finished basic and every scenario was "ok at this time I am going to call ALS or possibly set up an intercept" 

One was a broken ankle and I said I could handle it and I wouldn't call ALS. And I was marked wrong. Because ALS could give pain meds. 

SO from then on it was always ALS and NRB for every scenario.


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## bluefinmedic (Feb 14, 2011)

lampnyter said:


> Umm... No.



If you don't think every patient that you are bagging requires an OPA you might need to go back to EMT-basic school. That is the most basic skill, and can make a different between a adequate and inadequate ventilation.


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## Anjel (Feb 14, 2011)

bluefinmedic said:


> If you don't think every patient that you are bagging requires an OPA you might need to go back to EMT-basic school. That is the most basic skill, and can make a different between a adequate and inadequate ventilation.



You keep saying EVERY pt. That's where I disagree.

Contraindications?

Better choices?

Patient unconscious but throwing up or having a lot of salivation u need to keep suctioning. 

There could be better choices esp if you are a medic like your sn implies.


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## Shishkabob (Feb 14, 2011)

bluefinmedic said:


> If you don't think every patient that you are bagging requires an OPA you might need to go back to EMT-basic school. That is the most basic skill, and can make a different between a adequate and inadequate ventilation.





First...if I can maintain an airway without an OPA, so be it.  It's an adjunct to help, not a necessity.  


Second...  Being closed minded and saying "OPA OPA OPA" and ignoring other tools such as NPAs, Kings, ETTs, NTTs, surgical and needle crics, shows that you still have a ways to go in education.



Honestly, if given the choice between an OPA and NPA, I'd choose the NPA.  I've placed more NPAs than OPAs in my career.


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## reaper (Feb 14, 2011)

Ditto. Can't even remember the last time I used an OPA. Use NPAs all the time. Get past the basic school mentality.


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## usalsfyre (Feb 14, 2011)

bluefinmedic said:


> If you don't think every patient that you are bagging requires an OPA you might need to go back to EMT-basic school. That is the most basic skill, and can make a different between a adequate and inadequate ventilation.



You fail to understand TRUE airway management. I suggest reading Dr. Walls book. That is all.


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## lampnyter (Feb 14, 2011)

bluefinmedic said:


> If you don't think every patient that you are bagging requires an OPA you might need to go back to EMT-basic school. That is the most basic skill, and can make a different between a adequate and inadequate ventilation.



Lol ok. Thats why everybody agrees with me.


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## bluefinmedic (Feb 14, 2011)

Anjel1030 said:


> You keep saying EVERY pt. That's where I disagree.
> 
> Contraindications?
> 
> ...



I was referring to bagging an unconscious patient. It seemed like from the original posters question they were referring to npa vs. opa in these types of patients. Obviously there are better methods to secure an airway, but when it comes to basics there is no better option.


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## usalsfyre (Feb 14, 2011)

bluefinmedic said:


> I was referring to bagging an unconscious patient. It seemed like from the original posters question they were referring to npa vs. opa in these types of patients. Obviously there are better methods to secure an airway, but when it comes to basics there is no better option.



What if you unconscious patient still retains a gag reflex? Or is clenched? Or is doing a bang up job of maintaining airway tone but yet requires some ventilatory assistance (massively unlikely I know)?


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## fast65 (Feb 14, 2011)

bluefinmedic said:


> I was referring to bagging an unconscious patient. It seemed like from the original posters question they were referring to npa vs. opa in these types of patients. Obviously there are better methods to secure an airway, but when it comes to basics there is no better option.



I think a lot of the debate is coming from the fact that the tone of your original post seemed to say that an OPA is a universal tool for airway management. It kind of failed to recognize that it's not just an adjunct that can cover the basis of all situations in which in unresponsive patient needs to be bagged.


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## bluefinmedic (Feb 14, 2011)

fast65 said:


> I think a lot of the debate is coming from the fact that the tone of your original post seemed to say that an OPA is a universal tool for airway management. It kind of failed to recognize that it's not just an adjunct that can cover the basis of all situations in which in unresponsive patient needs to be bagged.



Someone close this post before it gets stupid in here.


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## reaper (Feb 14, 2011)

New basics come here to learn. You cannot make a blanket statement and then when everyone challenges your answer, you don't like it. 

An OPA is not needed in every unresponsive pt that needs ventilation assistance. You need to assess your pt and use what is needed.


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## fast65 (Feb 14, 2011)

bluefinmedic said:


> Someone close this post before it gets stupid in here.



Now was that really necessary? I made a non-confrontational statement about the possible cause of debate and you come back with that kind of a response. You might want to take a look in the mirror before you say something like that again, because it is a post such as that that really shows you lack the intellect to make an intelligent, PRODUCTIVE post.

EDIT: sticking to my advice about a productive post I will reiterate, what reaper said. Don't throw an OPA in every patient, take the time to assess their need for such a device.


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## Chimpie (Feb 14, 2011)

bluefinmedic said:


> Someone close this post before it gets stupid in here.



There is no need to close this thread. This has been an informative discussion that has brought up some very interesting points.  Just because you don't like the responses doesn't mean we will close it.

Moving forward...

Sent using the Tapatalk app!


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## usalsfyre (Feb 14, 2011)

bluefinmedic said:


> Someone close this post before it gets stupid in here.



Trying not to violate the "be polite" mandate...

You posted something that, to be blunt, was out and out wrong. You then asked the staff to close the thread because there were numerous post pointing out how flawed this line of thinking is. You appear to be a new medic/almost medic. At this point in your likely to be wrong ALOT. If people tell you your wrong (especially multiple people) you would be much better served at this point in your career by examining your own thought process and how it may be flawed. 

You will encounter many patients that don't require an OPA. I haven't used an OPA in >6 months, as I can place a King airway as quickly as I can place an OPA, and the King is kinda like a "SuperOPA". In that same time period I have used a great many NPAs. Often on unconscious patients. Airway management often doesn't require the most invasive option, it's actually usually better to go with the least.


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## TransportJockey (Feb 14, 2011)

usalsfyre said:


> You fail to understand TRUE airway management. I suggest reading Dr. Walls book. That is all.



Title of book please


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## Shishkabob (Feb 14, 2011)

jtpaintball70 said:


> Title of book please



Manual of Emergency Airway Management.

http://www.amazon.com/Manual-Emergency-Airway-Management-Walls/dp/0781747643


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## TransportJockey (Feb 14, 2011)

Linuss said:


> Manual of Emergency Airway Management.
> 
> http://www.amazon.com/Manual-Emergency-Airway-Management-Walls/dp/0781747643



Thanks man


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## JJR512 (Feb 14, 2011)

bluefinmedic said:


> If you don't think every patient that you are bagging requires an OPA you might need to go back to EMT-basic school. That is the most basic skill, and can make a different between a adequate and inadequate ventilation.



I just _finished_ EMT-B school and do not recall ever being taught that "every patient [I am] bagging requires an OPA".


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## Anjel (Feb 15, 2011)

JJR512 said:


> I just _finished_ EMT-B school and do not recall ever being taught that "every patient [I am] bagging requires an OPA".



Yup just finished too. 

And don't remember hearing that. I heard OPA is a very useful tool that is used as an adjunct when needed. 

Which I think answers the original question of the thread. OPA or NPA?

Use your best judgment and remember they aren't a fix but can help. And neither will secure an airway completely. So always monitor.


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## EMSslick536 (Mar 4, 2011)

*Opa*

Usually an OPA... If suspected head trauma.... Crack in the skull + O2? = One hell of a shift.


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## fast65 (Mar 4, 2011)

EMSslick536 said:


> Usually an OPA... If suspected head trauma.... Crack in the skull + O2? = One hell of a shift.



Not really sure what you mean by that exactly


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## Shishkabob (Mar 4, 2011)

fast65 said:


> Not really sure what you mean by that exactly



I guess the brain really really hates oxygen and would rather be anoxic when it possibly needs it the most?


Silly brains.


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## 8jimi8 (Mar 4, 2011)

MrBrown said:


> Risk of nasal airway use and head injury is significantly overstated, just be careful, if significant resistance is encountered then stop and try the other nostril.




It may be overstated, but is it prudent to tell people its ok to use an NPA in someone where head trauma is under suspicion?


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## AndyK (Mar 4, 2011)

8jimi8 said:


> It may be overstated, but is it prudent to tell people its ok to use an NPA in someone where head trauma is under suspicion?



Brown is quite right, Sir! What he possibly hasn't made clear is that there is a caution attached to using NPA's with head injuries but it's certainly not a contraindication.


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## 8jimi8 (Mar 4, 2011)

AndyK said:


> Brown is quite right, Sir! What he possibly hasn't made clear is that there is a caution attached to using NPA's with head injuries but it's certainly not a contraindication.



The spine is very hard to damage.  If someone sustained injuries enough to injure their back, i would be VERY suspicious for head trauma as well.

consider throwing a lollipop down hard enough to break the stick...



In any case, what I learned was that suspected basilar skull fracture was a contraindication,

what did everyone else learn? 

 I for one would rather use airway maneuver like a jaw thrust/sellicks to manage an airway if i did not feel comfortable.


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## fast65 (Mar 4, 2011)

That's kind of what I was thinking, but I wasn't sure. I know that none of my patients with a head injury will get oxygen, no sir, because after 4-6 minutes with oxygen, the brain cells start to die, right?

The above was directed at Linuss btw


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## AndyK (Mar 4, 2011)

8jimi8 said:


> In any case, what I learned was that suspected basilar skull fracture was a contraindication



It used to be, I certainly remember being told that aswell, but the tutor on my last update training stated it's now "with caution" rather than an absolute contra.


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## Anjel (Mar 4, 2011)

I was taught it was a CONTRADICTION....

BUT read this. Third page under conclusions. OORRR first page. Half way through the first paragraph....

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726817/pdf/v022p00394.pdf


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## 8jimi8 (Mar 4, 2011)

Anjel1030 said:


> I was taught it was a CONTRADICTION....
> 
> BUT read this. Third page under conclusions. OORRR first page. Half way through the first paragraph....
> 
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726817/pdf/v022p00394.pdf



excellent


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## reaper (Mar 4, 2011)

This is not new information. It is just still taught, because idiots put the fear in new students. 

This happens to be a question I ask every trauma Dr i meet. I have never had one that agreed with this myth. Of course if you have out of date med control, then you must follow what they say. So follow your protocols.


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## 8jimi8 (Mar 4, 2011)

Imagine if they really taught what we need to know rather than perpetuating misinformation.  


I DONT KNOW WHY I WOULD EVER QUESTION HELICOPTER DOCTOR BROWN


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## JJR512 (Mar 4, 2011)

8jimi8 said:


> Imagine if they really taught what we need to know rather than perpetuating misinformation.



It's not as simple as that.

What we need to know is constantly changing and evolving. Medical science isn't new but it's still growing. Relative to medical science, modern emergency medicine (with ambulances and field providers with training a bit more extensive than how to operate the stretcher) is still somewhat young.

On top of that, what one group thinks is best might not be what another group thinks is best. One state might subscribe to one group's point of view and another state subscribes to another point of view. That's why some EMT-Bs can do simple airways or check blood sugar levels while others can't.

And most of the people perpetuating misinformation aren't doing it deliberately. They're just repeating what they were taught, which was most likely true at one point in time, at least according to what one research group believed at the time.


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## Aprz (Mar 4, 2011)

fast65 said:


> That's kind of what I was thinking, but I wasn't sure. I know that none of my patients with a head injury will get oxygen, no sir, because after 4-6 minutes with oxygen, the brain cells start to die, right?
> 
> The above was directed at Linuss btw


I really hate trying to sounds intelligent so please forgive me in advance. That's kind of true with head injuries, but somebody also summed it up pretty well on another thread, which was on increased ICP, as the deadly twins: hypoxia and hypotension, and later somebody appended hypercapnia and called it the deadly triplets (how I remember it now). Too much O2 is bad, and that's probably because of free radicals (the guys hurting the brain), and stenosis in the brain since O2 is a vasoconstrictor , but giving them a little bit of O2 may be beneficial (saturate hgb w/ O2, increase BP to prevent ischemia, but don't give too much that you close the vessels and cause it). I'd guess that a NC @ 4-6 L/m would probably be the right dose.


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## fast65 (Mar 5, 2011)

Aprz said:


> I really hate trying to sounds intelligent so please forgive me in advance. That's kind of true with head injuries, but somebody also summed it up pretty well on another thread, which was on increased ICP, as the deadly twins: hypoxia and hypotension, and later somebody appended hypercapnia and called it the deadly triplets (how I remember it now). Too much O2 is bad, and that's probably because of free radicals (the guys hurting the brain), and stenosis in the brain since O2 is a vasoconstrictor , but giving them a little bit of O2 may be beneficial (saturate hgb w/ O2, increase BP to prevent ischemia, but don't give too much that you close the vessels and cause it). I'd guess that a NC @ 4-6 L/m would probably be the right dose.



You see, here's the thing about ICP. In a patient with increased ICP you're kind of stuck in the middle; on one end you have a risk of cerebral herniation, and on the other end you have the risk of ischemia. So, as ICP increases the body begins to compensate by decreasing CPP, which then results in an increase in MAP, causing vasodilation and increased cerebral blood flow; this process increases ICP even more and exacerbates the patients condition. Now, if we give the patient oxygen then that vasoconstriction should shunt some of the blood away from the patients head, allowing for a decrease in ICP. So we would want to give high-flow oxygen, correct? 

But, on the other end, if cerebral blood flow decreases, then CPP does as well, this results in the brain becomes ischemic and brain cells will soon begin to die. So, without being able to determine CPP in the field, how do we walk that fine line? Do we try to determine the lesser of the two evils?

This is just my understanding of ICP so far, I'm pretty new to the topic, so if anyone has anything to add, or anything to correct, please do so.


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## Aprz (Mar 5, 2011)

I was taking a stab at this, I don't really know it. I don't want to give you the wrong info, it was wrong of me to have people believe a NC is appropriate for all patients (I didn't clarify this), it's based on the patient (e.g. the patient is unconscious with irregular respirations then you may want to ventilate them instead), and I don't want to deviate further from the topic on airway adjunts so....

There is an old thread on ICP http://www.emtlife.com/showthread.php?t=72
One on Cushing's Triad that's more recent http://www.emtlife.com/showthread.php?t=21998
The EMTSpot has a thing on head injuries http://theemtspot.com/2009/07/16/treatment-of-head-injury/

I think if you are monitoring EtCO2, I think you could determine if they are getting too much or too little oxygen.

or we could create a new one again. <_<

I'd like to add to an earlier question about what does our local EMT program teach. They teach that significant head trauma is a contraindication for NPAs. You guys have posted up enough statistics and information on the unlikeliness of sticking it in the brain though so maybe they'll eventually change to "with caution" like I read somebody else program does.


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## Anjel (Mar 5, 2011)

Aprz said:


> I was taking a stab at this, I don't really know it. I don't want to give you the wrong info, it was wrong of me to have people believe a NC is appropriate for all patients, it's based on the patient (e.g. the patient is unconscious with irregular respirations then you may want to ventilate them instead), and I don't want to deviate further from the topic on airway adjunts so....
> 
> There is an old thread on ICP http://www.emtlife.com/showthread.php?t=72
> One on Cushing's Triad that's more recent http://www.emtlife.com/showthread.php?t=21998
> ...



Almost every thread about oxygenation and ventilation and airway turns into 

Oxygen bad or good. 

Whether or not oxygen is good or bad. Or an npa is used or an opa is used. It doesnt matter what is right or what you believe. Its just what your protocols say. If your protocols say no one with a skull fracture gets an npa then no one with a skull fracture gets an npa. 

One of those threads were mine and I still didn't get the answer I was looking for lol. Because it turned into o2 vs no o2.


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## Aprz (Mar 5, 2011)

Haha, I know what you mean. That's why I decided to step off a little bit and turn it back to airway adjuncts. Some of us have cool protocols where it's not the end all final answer. In the county I live in, on the very first few pages somewhere, it says that "sound medical judgement supercedes protocols; these are only guidelines". I don't think it means do whatever the heck you want, but also saying use your brain and treat appropriately, not just because the protocol says so. I think that's where conversations like this turn out to be nice. By the way, that's me paraphrasing the protocol, not quoting it word to word verbatim. :s

Edit: It says



> Treatment algorithms should be used as a guideline and are not inteded as a substitute for sound medical judgement. Unusual patient presentations make it impossible to develop a protocol for every possible patient situation.


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## AMF (Mar 10, 2011)

*$.02*

http://theemtspot.com/2009/12/08/the-art-of-the-nasopharyngeal-airway/#more-2059


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## calebsheltonmed23 (Mar 11, 2011)

If they have a head injury use a nose hose.


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## Anjel (Mar 11, 2011)

calebsheltonmed23 said:


> If they have a head injury use a nose hose.



uhh huh? is this your belief and practice? Or your protocols?


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## calebsheltonmed23 (Mar 12, 2011)

Anjel1030 said:


> uhh huh? is this your belief and practice? Or your protocols?



Sorry I put that up wrong.  If they have a head injury, do not use an NPA.  Sorry bout that!


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## Anjel (Mar 12, 2011)

calebsheltonmed23 said:


> Sorry I put that up wrong.  If they have a head injury, do not use an NPA.  Sorry bout that!



LOL i thought that might of been a typo


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## reaper (Mar 12, 2011)

calebsheltonmed23 said:


> If they have a head injury use a nose hose.



Kinda of a broad blanket statement!


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## lightsandsirens5 (Mar 12, 2011)

Anjel1030 said:


> Almost every thread about oxygenation and ventilation and airway turns into
> 
> Oxygen bad or good.
> 
> ...



I'll tell you what the problem is...(in my opinion at least)

Underneath it is not a case of O2 good or O2 bad. It is more of a case of all or nothing. Not every pt needs O2. But some do. Not every head trauma pt is an absolute contra for an NPA, but some are. Not every MVA pt needs c-spine, but some do. The problem arises here. If some pts need these interventions (or don't need them as the case may be), then either all or none of them will have the procedure in question done (or not done) to them. Why? Because those of us in EMS have become content with the trained monkey occupation. Where _some_ people need to be c-spined, so all of them are cause us monkeys cant tell the difference. Where every freaking pt gets O2, 15 Liters a minute via a non-re-breather mask, because _some_ might need it.  

Do you see the problem? It is not the protocols. They are the absolute best we can have with the system we currently have. The problem is we are a bunch of trained chimps, the best of whom are (to steal a term from firetender) flesh mechanics. "Hmmmm...belt is squeaking? Check the books....ok, replace tensioner. Well, that didn't work. Lets clean the pulleys. Oh wait.....that didn't work either......" 

Ok, bad analogy, I know, but I think you all get the point. Maybe if we were actually trained to recognize problems and treat _them _we would start to actually treat patients. We might possibly improve patient outcome. Maybe we would improve some of those statistics that have improved a whopping 0.01% since 1973.

/end rant.

Sorry to spout off like that. But I really need to scream at someone (for other reasons than this....lol....) and this kind of got me excited. 

I don't think that was too off topic considering this thread has already seemed to have drifted off course somewhat.


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## MrBrown (Mar 12, 2011)

lightsandsirens5 said:


> ....We might possibly improve patient outcome. Maybe we would improve some of those statistics that have improved a whopping 0.01% since 1973.



What would you possibly know about 1973 apart from what your read in a history book?


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## lightsandsirens5 (Mar 12, 2011)

MrBrown said:


> What would you possibly know about 1973 apart from what your read in a history book?


And what would you know you brown bugger? You ain't that much older than me. ^_^


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## Anjel (Mar 12, 2011)

lightsandsirens5 said:


> I'll tell you what the problem is...(in my opinion at least)
> 
> Underneath it is not a case of O2 good or O2 bad. It is more of a case of all or nothing. Not every pt needs O2. But some do. Not every head trauma pt is an absolute contra for an NPA, but some are. Not every MVA pt needs c-spine, but some do. The problem arises here. If some pts need these interventions (or don't need them as the case may be), then either all or none of them will have the procedure in question done (or not done) to them. Why? Because those of us in EMS have become content with the trained monkey occupation. Where _some_ people need to be c-spined, so all of them are cause us monkeys cant tell the difference. Where every freaking pt gets O2, 15 Liters a minute via a non-re-breather mask, because _some_ might need it.
> 
> ...



Haha I enjoyed reading this. You ranted about every frustration I have regarding the EMS system. Well not every one but most.  

I just finished EMT-B and have already figured this out. Whoever started this whole training thing decided we weren't able to decide what's best for our patient. So they laid out steps for us to follow. But humans are all different. The one guy having a heart attack is different from the one next store having a heart attack. In fact I remember my practicals. If you did not place the heart attack patient on a NRB 15 lpm it was an autofail. Failure to place pt on high flow O2 was what the sheet said. 

I wish we could have more decision making abilities. I don't like being programmed a certain way but then I look at the kids that passed my class and I wouldn't trust them to make decisions to save my pet rock. So I guess it goes both ways.


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## FrostbiteMedic (Mar 12, 2011)

Anjel1030 said:


> Haha I enjoyed reading this. You ranted about every frustration I have regarding the EMS system. Well not every one but most.
> 
> I just finished EMT-B and have already figured this out. Whoever started this whole training thing decided we weren't able to decide what's best for our patient. So they laid out steps for us to follow. *But humans are all different. **The one guy having a heart attack is different from the one next store having a heart attack.* In fact I remember my practicals. If you did not place the heart attack patient on a NRB 15 lpm it was an autofail. Failure to place pt on high flow O2 was what the sheet said.
> 
> I wish we could have more decision making abilities. I don't like being programmed a certain way but then I look at the kids that passed my class and I wouldn't trust them to make decisions to save my pet rock. So I guess it goes both ways.



That is exactly the point many have made in the past. We don't bring the textbook with us on the ambulance (protocol manual is there, but that is moot point) because everyone presents differently. A good EMT or Medic remembers that and applies their knowledge to the patient's care, rather than just performing their skill set. That is the problem that I have with the way that some of our testing and evaluation- you may effectively manage the patient within your scope of care, but because that effectiveness was not "by the book" so to speak, you 'must' have done something wrong. It leaves no room for the application of lessons learned. 

*gets off the soapbox*


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