NPA Usage.

I love my paddles..... used them last month once. Felt good. Just like the 80's again. Ahhhhhhhhhhh.

The NPA is one of the most useful diagnostic aids I carry in the medic unit. I am not much into painful stimulus stuff any more... sternal rubs, fingernail crushes ( except for neurological deficit testing ). Occasionall maybe a pinch of the skin just below the anterior portion of the shoulder... very sensitive.
If they are unconscious.... NPA. Not many folks can take that without a flinch. If they are seizing.... NPA. Easy and quick. IF the ventilations from the BVM are just not getting it done... NPA. It helps.

( just my take on it ). My guedels and Bermans have dust on them. sigh..
 
I've used NPAs several times for unresponsive unknowns. Never had a problem with them. But after having to put one in myself during medic school I'm always a little more careful about inserting them than before.
 
Hm, after having read all that, would everyone agree that-

Anytime Pt has trouble support own airway, use npa.
If Pt is in vegetative state, seized, aloc, but breathing normal rate good volume, no use.
 
Unfortunately, simplifying things down to black & white, yes or no, dichotomies is often not appropriate in EMS.

I think that in itself is a big learning curve for almost everyone. At some point you just realize that operating in shades of gray and using critical thinking skills are more important than following a formula.

As far as NPAs go, most of the time they will not cause harm and may be worth a shot if you're questioning using them or not. My opinion is, if you're wondering whether or not an NPA will benefit a patient, go ahead and give it a shot. I had a snoring, semi conscious OD pt take a swing at me when I tried to insert one once in the ED. I stopped. It didn't cause her any harm. The thing that might stop you from doing so is when you're wondering whether or not an NPA will cause harm, as in a patient with severe facial injuries. That's a reason to be conservative right there.
 
I believe textbook use would say that anyone having difficulty maintaining their own airway needs manual management and/or an adjunct; and that an OPA should be used unless the Pt has a gag reflex, in which case the NPA would be used. Facial trauma is a textbook contraindication as well.

But then again, how many patients are textbook?
 
At my school, the teachers said to just drop an OPA. If they have a gag reflex, go to an NPA but if they don't its all good. I guess it makes sense, because if they do have a gag reflex, the worst is a little gagging. (not quite sure if all patients go and puke.....) you just pull it out and shove in an NPA
 
helicub81 said:
At my school, the teachers said to just drop an OPA. If they have a gag reflex, go to an NPA but if they don't its all good. I guess it makes sense, because if they do have a gag reflex, the worst is a little gagging. (not quite sure if all patients go and puke.....) you just pull it out and shove in an NPA
Click to expand...

Why take the risk when you could have just used the NPA to begin with? If they do vomit, then you've got to add aspiration to the list of airway worries.
 
The better airway is the one that works without unnecessary risk of harm to your patient.
 
LucidResq said:
The better airway is the one that works without unnecessary risk of harm to your patient.
Click to expand...

This.

If they're going to choke on their own vomit, then the OPA isn't the better airway.

If you're going to be poking their brain with the NPA, then it isn't the better airway.

...Well, in the latter case, they're pretty much in trouble anyway.
 
helicub81 said:
Well I'd consider it because the OPA is a way better airway.
Click to expand...

All pharyngeal airways do pretty much the same thing, they use a rigid or semi rigid item to splint the upper airway open. They do nothing to reduce aspiration risk or gastric distension. If I had to choose one exclusively, I'd go with the NPA as it works for a much wider patient population than the OPA. If they can accept an OPA, they can accept a King LTS-D, which basics all over the country have been trained to safely use. This is one of the few times I think basics should be allowed to perform an invasive procedure.

As long as we're talking about airways and the 80s in the same thread, who remembers the EOA? Bonus points for who can remember what the acronym stood for.
 
Esophageal Obturator Airways?

Read about them, but I'm new enough I've never seen one used.
 
CAO FTW!

Actually, I'm new enough I SHOULDN'T have seen one. Unfortunately I believe it was 2003 before they were no longer required equipment to be a BLS transport unit in Virginia, which was well past their sell by date...
 
usalsfyre said:
CAO FTW!

Actually, I'm new enough I SHOULDN'T have seen one. Unfortunately I believe it was 2003 before they were no longer required equipment to be a BLS transport unit in Virginia, which was well past their sell by date...
Click to expand...

They were replaced by combitubes by the mid-90s. Virginia just required some blind airway device, the regs didn't hold you to a certain one.

I saw one used once, on a cardiac arrest that the crew worked for just over an hour, with a 23 minute response time. After my preceptor called the code, they pulled the lines and pointed out the lividity. Sigh. The good ole days, when we "made a difference" every day. :)
 
usalsfyre said:
CAO FTW!
Click to expand...

Haha, nah. FTL.

Still don't have an EMS job despite being in Medic school. All I get to do is read and practice on dummies unless I'm on clinicals <_<

Thankfully I have most of next week to do my rounds around here again to see if anyone is hiring.
 
Unless a seizure patient is status you usually do not need to use an airway adjunct. Just manually maintain the airway and suction any secretions as needed. Most seizure patients come to in no time and become postictal with no airway issues. If its a tonic-clonic seizure you prob won't be able to get an OPA in due to trismus (jaw clenched) so an NPA would be your better airway if you opt to use one.

Some seizure patients seize several times a day and they do fine without any OPA or NPA.
 
18G said:
Unless a seizure patient is status you usually do not need to use an airway adjunct. Just manually maintain the airway and suction any secretions as needed. Most seizure patients come to in no time and become postictal with no airway issues. If its a tonic-clonic seizure you prob won't be able to get an OPA in due to trismus (jaw clenched) so an NPA would be your better airway if you opt to use one.

Some seizure patients seize several times a day and they do fine without any OPA or NPA.
Click to expand...
How about using an oral screw? Anyone remember using one? At one time I was trained to use one but... that was nearly 20 years ago.

I used to work for an aquatic rehab facility. We had clients who were prone to seizure, and would do it several times in an hour. Yes, that's on anti-seizure meds. They'd seize, and pop right back out of it. We're talking short seizure, and almost NO postictal period that I could determine. And no, they didn't require any airway adjuncts. None.

IMHO, if you have to use a BVM on a seizing patient, put in an NPA while they're actively seizing as an OPA won't likely work. You'd need an oral screw to open the jaw, and chances are you'll damage teeth in the process, and then you'd be able to place the OPA.
 
You must log in or register to reply here.
Back
Top