opa or npa?

tssemt2010 said:
thats kind of situational, on a patient with a gag reflex, npa, if theyre unconscious and/or dont have a gag reflex, an opa would be the better option
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Agreed. Even tho my protocols say that the NPA is the preferred airway adjunct.
 
i agree, protocol goes with npa, but i think it is more of a situational thing
 
Say a PT has a skull fracture and still has a gag reflex but has an obstructed airway that couldnt be suctioned what would you do then?
 
FeatherWeight said:
Say a PT has a skull fracture and still has a gag reflex but has an obstructed airway that couldnt be suctioned what would you do then?
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No NPA and no OPA. Suction might still be able to be done. If the hard suction cath won't fit in the patients mouth use a soft suction cath that can be inserted in extremely small areas. BVM if needed.

ALS in my area can't RSI so no intubation. ALS in my area won't be able to do anything for airway that BLS can't do for this scenario, at least that I can think of.
 
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FeatherWeight said:
Say a PT has a skull fracture and still has a gag reflex but has an obstructed airway that couldnt be suctioned what would you do then?
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Get orders to properly insert an NPA. Working als, since we don't have RSI, I'd see if I can't get an order for high dose versed or morphine to knock out that gag reflex, suction, and try an OPA.
How far off is my thinking?
 
FeatherWeight said:
Say a PT has a skull fracture and still has a gag reflex but has an obstructed airway that couldnt be suctioned what would you do then?
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They won't have a gag reflex for long... ;) Or you could beat 'em to it with a little pharmacology :D
 
Interesting. NPA is not allowed to be used by BLS in King County Washington.
 
Wouldn't rsi be a little risky to icp in a the pt with a skull fx, depending on drugs u have available. I'd consider phenergen for the gag reflex, yes it does work no your girlfriends won't do that more lol but i would think that bls airway would, be better at that time dependent on pts response to that get more aggressive
 
thisgirlisamedic said:
Wouldn't rsi be a little risky to icp in a the pt with a skull fx, depending on drugs u have available. I'd consider phenergen for the gag reflex, yes it does work no your girlfriends won't do that more lol but i would think that bls airway would, be better at that time dependent on pts response to that get more aggressive
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"A consensus panel has addressed the question of poorer outcomes in prehospital patients with TBI who have been intubated. This panel found no prospective controlled trials to adequately address the efficacy of paramedic RSI for severe TBI.[35] "

http://www.medscape.com/viewarticle/585165
 
Wow hadn't seen that cool, our med director needs to check that out we still have to bolous steroids with rsi on an skull fx, i hate having to do all the extra if i don't have to, but like I said if it condition demands it or shows like it will ill do it, don't wanna be behind the game then it sucks to try to catch up lol
 
thisgirlisamedic said:
Wow hadn't seen that cool, our med director needs to check that out we still have to bolous steroids with rsi on an skull fx, i hate having to do all the extra if i don't have to, but like I said if it condition demands it or shows like it will ill do it, don't wanna be behind the game then it sucks to try to catch up lol
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Your med director may want to consider this one too then:

Corticosteroid Administration

"The main indication for the use of steroids is for the treatment of vasogenic edema associated with brain tu mors or accompanying brain irradiation and surgical manipulation.[71] Although the precise mechanisms of the beneficial effects of steroids in this paradigm are un known, steroids decrease tight-junction permeability and, in turn, stabilize the disrupted BBB.[61,91] Gluco cor ticoids, especially dexamethasone, are the preferred ster oidal agents, due to their low mineralocorticoid activity. The ther apeutic role of steroids in TBI and stroke has been studied extensively. In TBI, steroids failed to control elevations in ICP or to show any benefit in outcome, and they may even be harmful.[17,72] In stroke, steroids have failed to show any substantial benefit[64] despite some success in animal models.[93] Given the deleterious side effects of steroid use (peptic ulcers, hyperglycemia, impairment of wound healing, psychosis, and immunosuppression), until further studies are published, caution is advised in the use of steroids for cerebral edema unless absolutely indicated. The role of steroids in the treatment of bacterial meningitis and postinfectious encephalitis is beyond the scope of this article."


http://www.medscape.com/viewarticle/559004
 
or this one:

http://www.ncbi.nlm.nih.gov/pubmed/21262204

"The CII of MP treated rats was comparable to that of saline treated control rats before injury but was significantly decreased in injured rats receiving high-dose MP on post-injury day 7. Similarly, the incidence of acute CIRCI was significantly higher in the high-dose MP group on post-injury day 7. Furthermore, the CII of rats that did not survive post-injury was significantly lower compared to that of survival and was indicative of acute CIRCI. We also examined apoptosis in the paraventricular nucleus (PVN) of the hypothalamus and the adenohypophysis of the pituitary, using a TUNEL assay and transmission electron microscopy (TEM). The number of TUNEL-positive cells was significantly higher in injured rats treated with high-dose MP. No TUNEL-positive cells were detected in the adenohypophysis across experimental groups at either 7 or 14days after TBI. However, autopsies performed on rats that did not survive post-injury revealed obvious apoptotic cells in the adenohypophysis. Moreover, TEM revealed morphological changes characteristic of apoptosis in both the PVN and adenohypophysis of high-dose MP treated rats. These data suggest that MP therapy for TBI could increase neuronal apoptosis in both the hypothalamus and pituitary and consequently exacerbate acute CIRCI and mortality induced by TBI."
 
I had heard this and was talking to the neurologist at the university hospital about this, only thing we could figure out is that our med. Director is a little behind, or backwoods in his terms not mine, I have brought up concerns multiple times about many of our meds. But I never get anywhere, maybe that's why I'm looking for other employment, lol but thanks for the info I really enjoy these studies , and learning new things, it can really make a difference if u know what i mean, I don't think I could ever know enough, by the way what have u heard about the role of " prils" meds on the ability to recover from shock/ trauma
 
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