NPA Usage.

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Alas

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NPA and OPA- Specifically NPA, when should it be used? Had a situation where someone was doing fine one second, and went into seizure (petite mal, no twitching) Aox0, pain purpose/ pain withdraw. Slapped o2 and put on side. Pt was breathing normal rate of 22ish, v/s slightly elevated. Boss says i should put NPA next time. Others tell me it isn't nessesary. When should NPA be used, and where to draw the line?

Thank you,
Alas
 
One of my closest friends from high school has absence seizures (petite mal is the outdated name). If you tried to put an NPA in her nose she probably would have punched you when she came out of it.

One of the things with absence seizures is that they tend not to last very long, and I personally will only treat if they don't resolve after some time. If it doesn't resolve within a short time frame, I start to suspect it is a complex partial seizure and not an absence seizure. The absence of visible "twitching" doesn't necessarily make it an absence seizure, since they may be having motor activity that isn't visible to you. Something like their eyes jerking to one side, their mouth opening and closing, or something internal like intestinal spasms.

I wouldn't have used an NPA or O2 on this patient, unless I was using oxygen for some other issue and not the seizure.

So, to answer your question. I only use NPAs when I need a short term airway in a patient I think might have a gag reflex. Overdoses are the main situation that comes to mind, and also status generalized seizures with respiratory impairment, and maybe some sort of facial (lower jaw) trauma, but it really depends.
 
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Aidey said:
One of my closest friends from high school has absence seizures (petite mal is the outdated name). If you tried to put an NPA in her nose she probably would have punched you when she came out of it.

One of the things with absence seizures is that they tend not to last very long, and I personally will only treat if they don't resolve after some time. If it doesn't resolve within a short time frame, I start to suspect it is a complex partial seizure and not an absence seizure. The absence of visible "twitching" doesn't necessarily make it an absence seizure, since they may be having motor activity that isn't visible to you. Something like their eyes jerking to one side, their mouth opening and closing, or something internal like intestinal spasms.

I wouldn't have used an NPA or O2 on this patient, unless I was using oxygen for some other issue and not the seizure.

So, to answer your question. I only use NPAs when I need a short term airway in a patient I think might have a gag reflex. Overdoses are the main situation that comes to mind, and also status generalized seizures with respiratory impairment, and maybe some sort of facial (lower jaw) trauma, but it really depends.
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Isn't any facial trauma a contradiction for NPAs?
 
I used an NPA for the first time just the other day.

Walked in on a patient with snoring respirations, not responsive to any stimuli. Head tilt chin lift done, but snoring stayed. Lubed up an NPA and tossed it in, and snoring corrected.


Patient was a DNR, so I wasn't able to do anything more advanced. Wasn't going to attempt an OPA because if they DID have a gag reflex and vomited, sure I could suction, but it would have been a whole lot more sucky on the airway department.
 
I've used two in the last two days, both as rescue measures for seizing patients with airway risk when I couldn't open their jaw.
 
I use an NPA whenever someone presents with an altered mental status that needs airway assistance and still has a gag reflex.

Snoring respirations, secretions, suctioning, clenched teeth, or just deeply drunk...NPA.
 
abckidsmom said:
I use an NPA whenever someone presents with an altered mental status that needs airway assistance and still has a gag reflex.

Snoring respirations, secretions, suctioning, clenched teeth, or just deeply drunk...NPA.
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Do you consider the risks and benefits in all these patients?
 
LondonMedic said:
Do you consider the risks and benefits in all these patients?
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Forgot that I was posting on the EMS forum and needed to be prepared for an inquisition.

me said:
After considering the risks and benefits, I use an NPA whenever someone presents with an altered mental status that needs airway assistance after simple positioning maneuvers have failed to provide a patent airway and still has a gag reflex.

Snoring respirations, secretions, suctioning, clenched teeth, or just deeply drunk...NPA.
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When you are taking care of a patient with an altered mental status, would you NOT manage their airway? I'm not very clear what you're talking about here.
 
abckidsmom said:
When you are taking care of a patient with an altered mental status, would you NOT manage their airway? I'm not very clear what you're talking about here.
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Managing an airway does not necessarily mean sticking a piece of plastic in it.
 
abckidsmom said:
Can you spell it out for me then?
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My thought would be- If the PT is altered but they are talking, ot mumbling such, or any obvious signs of a patent airway, they don't need an NPA. If the PT is altered and breathing in in a very slow, almost absent manner (i.e. 4 breaths a minute), I'm likely going to throw an NPA in there and start bagging. If the PT comes around (narcan, D50, etc), and they don't need the assistance, it can be just as easily removed.

Generally speaking, while I am kinda new at this whole EMT thing, if I'm bagging a PT, I'm likely going to throw an adjuct in there- unless the PT is totally AOx3/4...in which case, bagging them won't be the easiest thing in the world anyways (although still doable).

I dunno, that's my two cents in the matter. If the PT can't protect their airway due to severe AMS and requires bagging, I'll use one. Otherwise, I'll just slap a NRB on and monitor their respirations.

edit- and yes, you more or less covered my thoughts I think in so few words in your post.
 
Amycus said:
Generally speaking, while I am kinda new at this whole EMT thing, if I'm bagging a PT, I'm likely going to throw an adjuct in there- unless the PT is totally AOx3/4...in which case, bagging them won't be the easiest thing in the world anyways (although still doable).
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Good practice to get in the habit of. If you're bagging someone, there should be no reason why an adjunct shouldn't be used.
 
abckidsmom said:
Can you spell it out for me then?
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Lots of patients who are altered can actually manage their airway fine, and while we should always suspect the possibility of airway compromise, things can often be made worse by being too aggressive.

To give you two examples, when I work nights on the wards I often hear patients with signs of incomplete airway obstruction, often waking them up and asking them to sleep on their sides fixes things. Recently I saw an unconscious patient with significant blood coming out of their mouth but no actual obstruction. I elected to leave them on their side with an OPA and suction in place until the sitaution was more amenable, rather than immediately dump them on their back and fill their oropharynx and larynx with blood whilst I buggered about with a laryngoscope.
 
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LondonMedic said:
Lots of patients who are altered can actually manage their airway fine, and while we should always suspect the possibility of airway compromise, things can often be made worse by being too aggressive.
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You realize they said "needs airway assistance" after "simple positioning maneuvers have failed", which means you kinda do need "plastic" (rubber, silicone, etc) to maintain the airway, correct?
 
Linuss said:
You realize they said "needs airway assistance" after "simple positioning maneuvers have failed", which means you kinda do need "plastic" (rubber, silicone, etc) to maintain the airway, correct?
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In his defense, I revised that into my statement, but it still felt pretty slammish when the examples of how not to insert plastic in the airway included an instance of inserting plastic in the airway.

But thanks for noticing. :)
 
Nasal airways are largely underutilised and risks associated with head injuries are significantly overstated.

If somebody with significant maxillofacial trauma is encountered which makes it very difficult or impossible to insert an oral airway then don't use one, that is common sense.

If putting one in and you encounter significant resistance, stop and don't force it.

Never used one and only seen one used once.

Oh and to think as recent as 2003 NPAs were an Intensive Care Paramedic skill here. How times have changed

*Brown looks at his Lifepak 10 and sighs ....
 
MrBrown said:
Nasal airways are largely underutilised and risks associated with head injuries are significantly overstated.

If somebody with significant maxillofacial trauma is encountered which makes it very difficult or impossible to insert an oral airway then don't use one, that is common sense.

If putting one in and you encounter significant resistance, stop and don't force it.

Never used one and only seen one used once.

Oh and to think as recent as 2003 NPAs were an Intensive Care Paramedic skill here. How times have changed

*Brown looks at his Lifepak 10 and sighs ....
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You poor dear...I miss that lovely red case, also...but it was extremely freeing *last week* when I threw out the last of the defib gel. (COME ON, People! We haven't even HAD any paddles for 8 years...why are we still carrying gel every time we pick up the bag?)

Any way, NPAs are a great tool to be had, and usually tolerated pretty well. You've seriously never used one? Interesting. They've allowed me to let go of plenty a modified jaw thrust that would have caused a major cramp in the hands by the time we got to the hospital. And cheap, too. Easily removed, and I've never seen anything more than a little bloody mucus caused by them.
 
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