OPA by EMR?

[ZombieEMT]

NJ EMTs use OPA and NPA, personally prefer NPA.

 

[jkmerrill]

Umm, wow. That's certainly more aggressive than most.

There was a study published in the European Journal of Emergency Medicine recently where they took lay visitors at a hospital, handed them a King LT and an instruction card, and asked them to insert the airway device in a dummy. More than half of them did so correctly. After that, a researcher took the King LT, demonstrated how to insert it, and asked the laypeople to insert it again. With that simple demonstration, 98% of the laypeople got the King LT in correctly.

When 98% of people off the street can put a King LT in after being shown how once, I don't think that we should be looking at a system that gives them to EMRs and saying "Wow, that's really aggressive." We should be looking at our own systems which guard supraglottic airways like some highly advanced skill and saying "Wow. We're hidebound and really conservative."

 

[NBFFD2433]

Depends on your state. We can use OPAs but have to take an advanced airway course before we can use NPAs.

 

[EEEMMMTTT]

certainly it isn't just if the King is easy enough to use, but to understand all the other conditions that goes with a situation where a patient would need a king.

 

[Carlos Danger]

certainly it isn't just if the King is easy enough to use, but to understand all the other conditions that goes with a situation where a patient would need a king.

The indications are the same as an OPA, which is universally a BLS skill.

Here's the protocol I would propose:

- If they tolerate an OPA, exchange it for a King.

- If they don't tolerate the OPA, then don't attempt to place a King.

Simple 'nuff.

 

[Carlos Danger]

When 98% of people off the street can put a King LT in after being shown how once, I don't think that we should be looking at a system that gives them to EMRs and saying "Wow, that's really aggressive." We should be looking at our own systems which guard supraglottic airways like some highly advanced skill and saying "Wow. We're hidebound and really conservative."

My thoughts exactly.

I would even take the ease of placement argument a few steps further and probably make <insert your favorite SGA device here> the primary airway for all levels of care.

All levels would be able to place the SGA, and the only folks placing ETT's and doing RSI would be small groups of paramedics with lots of extra airway training.

 

[nwhitney]

Just out of curiosity, what part of Oregon are you from? And is King, Combi part of your state protocols or just where you're from?

I'm in Oregon (Portland to be more precise) and King/Combi is within the statewide scope.

 

[jkmerrill]

certainly it isn't just if the King is easy enough to use, but to understand all the other conditions that goes with a situation where a patient would need a king.

If you took that argument to its logical conclusion, we should all switch to the Franco-German model of EMS where ambulances are staffed by physicians and our profession more-or-less exists to drive them around. Ultimately, the risk of harm by letting lower-level personnel use this particular intervention is pretty small compared with the potential benefit of having a patent airway on a patient who otherwise wouldn't have one.

Jason Merrill

 

[jkmerrill]

My thoughts exactly.

I would even take the ease of placement argument a few steps further and probably make <insert your favorite SGA device here> the primary airway for all levels of care.

All levels would be able to place the SGA, and the only folks placing ETT's and doing RSI would be small groups of paramedics with lots of extra airway training.

Given the number of times which I've seen EMS practitioners at all levels use an improperly sized and inserted OPA to jam the tongue into the back of an airway which might have otherwise been patent on its own or with simple airway manoeuvres, I tend to agree with you. In my ideal world every MFR out there would have access to an SGA, and while I try to keep an open mind I have yet to hear an argument to the contrary which doesn't sound like turf protection.

Jason Merrill