Nonrebreather with an Oral Airway?

[M1ke10191]

So all along my 2 month EMT class, during our trauma assessment we all verbalized placing a NRB after the OA was inserted to take care of the A and B of the ABCs. Yesterday one of the staff members told us if you're going to put in an OA you automatically would ventilate. I mean the patient is unconscious yet he is still breathing adequately in the scenario. He doesn't show any signs of inadequacy. Would a nasal airway + NRB be better both in real life and the practical (Which is in 8 hours btw lol), were we right with the OA + NRB, or was the instructor right saying NRB + ventilate?

We don't go too in depth in our class, honestly I think they're teaching JUST enough to pass the exam, but that's another thread entirely. Also, I've been riding with my rescue squad for 6 months now and I've seen OA's used but back then I didn't know what was going on.

 

[VentMedic]

So all along my 2 month EMT class, during our trauma assessment we all verbalized placing a NRB after the OA was inserted to take care of the A and B of the ABCs. Yesterday one of the staff members told us if you're going to put in an OA you automatically would ventilate. I mean the patient is unconscious yet he is still breathing adequately in the scenario. He doesn't show any signs of inadequacy. Would a nasal airway + NRB be better both in real life and the practical (Which is in 8 hours btw lol), were we right with the OA + NRB, or was the instructor right saying NRB + ventilate?

We don't go too in depth in our class, honestly I think they're teaching JUST enough to pass the exam, but that's another thread entirely. Also, I've been riding with my rescue squad for 6 months now and I've seen OA's used but back then I didn't know what was going on.

I believe they are now advocating this in CCR but it has its limitations.

You can open the airway to allow more effective ventilations with an OA. However, you will now leave that patient to close off their airway with aspiration. Whatever secretions are in their cavity will now be in their lungs. If the patient regains their gag reflex, whatever was in their stomach will now be in their lungs. Thus, the person will die another death, and not a very pleasant one, even if they regain ROSC.

If you use an OA, you must keep watch on it. It is not meant to be placed and forgotten.

And, review the difference between oxygenation and ventilation.

 

[rescue99]

So all along my 2 month EMT class, during our trauma assessment we all verbalized placing a NRB after the OA was inserted to take care of the A and B of the ABCs. Yesterday one of the staff members told us if you're going to put in an OA you automatically would ventilate. I mean the patient is unconscious yet he is still breathing adequately in the scenario. He doesn't show any signs of inadequacy. Would a nasal airway + NRB be better both in real life and the practical (Which is in 8 hours btw lol), were we right with the OA + NRB, or was the instructor right saying NRB + ventilate?

We don't go too in depth in our class, honestly I think they're teaching JUST enough to pass the exam, but that's another thread entirely. Also, I've been riding with my rescue squad for 6 months now and I've seen OA's used but back then I didn't know what was going on.

If you need an oral airway then your victim has no gag relfex. If the victim hasn't gagged and comprimised his (or her) airway, it will happen. There's likely much more going on. A nasal is most appropraite for the victim described.

 

[Ridryder911]

If you need an oral airway then your victim has no gag relfex. If the victim hasn't gagged and comprimised his (or her) airway, it will happen. There's likely much more going on. A nasal is most appropraite for the victim described.

I disagree. If your patient has no gag reflex, then there is issues that needs to be addressed. Mask or cannula, one has to continuous monitor the airway for the potential risks of aspiration.

Personally I like the NPA and if no trauma, place in recovery position and monitor the airway with a NRBM if only oxygen therapy is needed.

Alike Vent was describing the difference between oxygenation and ventilation is the key point. If your patients AMS was secondary to hypoxia induced, then of course proper oxygenation should be the preferred treatment.

 

[rescue99]

I disagree. If your patient has no gag reflex, then there is issues that needs to be addressed. Mask or cannula, one has to continuous monitor the airway for the potential risks of aspiration.

Personally I like the NPA and if no trauma, place in recovery position and monitor the airway with a NRBM if only oxygen therapy is needed.

Alike Vent was describing the difference between oxygenation and ventilation is the key point. If your patients AMS was secondary to hypoxia induced, then of course proper oxygenation should be the preferred treatment.

What the hey are you disagreeing with? Once again, we're in agreement!

 

[M1ke10191]

Well I just got home from my practicals (passed everything) and I made sure to ask the proctor if the pt's breathing was adequate. She said yes so i said OA + NRB. What none of us were expecting was for our trauma patients to wake up halfway through the assessment. I took out the airway and verbalized his airway was patent for nowe but if needed I could always toss in a nasal airway. So all in all, I was right in my thinking.

 

[Ridryder911]

What the hey are you disagreeing with? Once again, we're in agreement!

oops... sorry!

R/r 911

 

[fma08]

:blink: Rid is agreeing with someone!!??

 

[rescue99]

:blink: Rid is agreeing with someone!!??

Rid agrees with me all the time..he just argues about it

 

[Ridryder911]

:blink: Rid is agreeing with someone!!??

Hey, just like Dr. Cox just because I may say the same thing as another, does not always imply I am agreeing..

R/r 911

 

[MrBrown]

If the patient is unconscious with no gag reflex but breathing (either spontaneously or normally) I'm not sure .... go with an OPA or NPA with supplumental oxygen and ensure it's adequate.

If not I'd probably drop in an LMA and see if the patient is compliant with a bag mask.

 

[fma08]

Hey, just like Dr. Cox just because I may say the same thing as another, does not always imply I am agreeing..

R/r 911

“I apologize. I am a horse’s ***.”

 

[AZFF/EMT]

Had a call similar last night. 40 y/o Female out drinking. Husband picked her up and halfway home she became unresponsive. U/A she was unc/unr vitals all normal, breathing good on her own clear and equal, good rise and fall SaO2 100% on room air, - oral secretions, - vomit. History of Arthritis only. Per protocol since she was out drinking she recieved some narcan, IV with a bolus and monitor. I placed her in a recovery position put an OPA on her cheek held there with the NRB strap, BVM out on her chest and had suction ready. Had zero complications, no changes and hospital left her how I had her. Vitals avg 140/90, 105 Sinus SR, 18NL, 100% o2, Pearl, GCS 3 then 1/1/2 at the hospital.



Medic student I had with me wanted to OPA and BVM from the start, I choose to go the other way, but be ready for any problems.

What is everyones take on a situation like this?

Who would have tubed her?
Who would have King Airway her?
BVM w/OPA?
NRB w/OPA?

 

[mycrofft]

Oropharyngeal airways?

Prone to becoming an upper airway problem themselves, flanges too small, need attention. Also since no airway seal, any bleeding from trying to get them in can become an embarassment (literally).

As for BVM versus passive mask, play it as it lies. Just don't expect to put an OP airway in and them go to the next pt without risk of iatrogenic trouble.

 

[Smash]

Who would have tubed her?

Depends. How far from hospital, what kind of egress we have, what medications, what else (if anything) other than alcohol had she taken, what was her blood glucose. Too many questions left unanswered to give an answer one way or another. She has an unprotected airway with a high risk of soiling that airway so generally speaking I would prefer it to be more secure. I know we are blase (sorry, can't get the accent on there) about it being ETOH, but we shouldn't be.

Who would have King Airway her?

Don't have them, so not an option.

BVM w/OPA?
NRB w/OPA?

See above.

since she was out drinking she recieved some narcan

What? No, really? People still do that?

 

[akflightmedic]

Narcan for only ETOH??

Not do people still do that, but did people ever do that??

 

[MrBrown]

Narcan for only ETOH??

Not do people still do that, but did people ever do that??

Naloxone for a drunk, um ...... *scratches head, maybe, if, well, um, hmmmm .... *scratches head again, just not making sense.

Perhaps talking a coma cocktail of naloxone and IV glucose (I've also heard of flumazenil (which is nasty, evil muck) and thiamine but neither of which we carry) ... but heck that's like eighties style surely we arent still doing that!

What is everyones take on a situation like this?

Drunk who had too much and fell down; can't protect her own airway so I'd drop an LMA.

 

[Smash]

I assumed it was part of the coma cocktail approach. It staggers me nonetheless.

 

[SurgeWSE]

Let me start by saying...I really hate Narcan. I don't like dealing with seizing, combative, or puking junkies. That said, if my options are intubating someone (EtOH or no, a GCS of 3 is a candidate) or try Narcan, I'd give the meds a shot before I tubed them.

As to the original question, if the person tolerates an OPA and is ventilating/oxygenating appropriately without a bag, go with OPA and whichever O2 method is appropriate. There's no point in increasing the potential for a bad airway by bagging someone who doesn't need it and causing unnecessary gastric insufflation. Just remember, if no advanced airway is available and the person tolerates an OPA, you'll need to be hypervigilant for emesis/secretions and prevent aspiration.

 

[emtjack02]

If they are truly a GCS of 3 then they really do not have the ability to protect their airway should the have an emesis. It only takes one time to get a complex pneumonia. I think I would go with an ETT. An LMA does not have aspiration protection to my knowledge. An OPA would probably work but it doesnt truly protect the airway. And yes we do narcan for our unc/unk protocol.