OPA or NPA?

MedicDelta

MedicDelta

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Hey guys, just wondering what you go to first for an unresponsive patient who has no facial trauma. Do you attempt an OPA first and if there's a gag reflux go to an NPA? Or do some of you just go straight to an NPA? The way I was taught was to try an OPA first and then if there is a gag reflux present attempt to insert an NPA. Honestly, I can't remember why or if we were even taught why. I'm guessing it has to do with the fact that NPAs may not protect the patient from aspiration or the fact that it's more dangerous to use? I don't know, but that's how I was taught. What were you guys taught, and do you do it that way or differently?
 
I'll go for an OPA first. It does a better job at holding the tongue out of the way. However it offers zero protection from aspiration.

If the patient accepts the OPA then the patient is pretty much going to get intubated (unless there is an easily reversible cause for the ALOC).

If the patient has a gag reflex then I'll probably toss in a NPA.
 
OPAs go in on cardiac arrests. Other calls its more discretionary. Obviously if they are trismused we will not be using an OPA. Overdose? probably an NPA in case they wake up on their own.
 
An NPA for an unresponsive medical patient (which usually comes out after the Narcan goes in)

A patient being actively bagged without a gag gets 2 NPAs and a OPA... usually quickly followed by a tube.
 
If I determine that the airway is actually compromised, sometimes I'll go with an OPA. Sometimes I'll go with an NPA. When I use an NPA, it's because I think there's a good chance the patient may wake up or if I can't use an OPA. First thing done... jaw-thrust. While getting into position to do that, I can assess the pupils, check for trismus...
 
I wouldn't stick in an OPA unless you're pretty sure there's no gag reflex. Doing them "empirically" on everyone is a good way to cause vomiting and a much bigger airway problem.
 
DesertEMT66 said:
I'll go for an OPA first. It does a better job at holding the tongue out of the way. However it offers zero protection from aspiration.

If the patient accepts the OPA then the patient is pretty much going to get intubated (unless there is an easily reversible cause for the ALOC).

If the patient has a gag reflex then I'll probably toss in a NPA.
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Interesting, thanks for the input
 
DEmedic said:
An NPA for an unresponsive medical patient (which usually comes out after the Narcan goes in)

A patient being actively bagged without a gag gets 2 NPAs and a OPA... usually quickly followed by a tube.
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2 NPAs? I've never heard of that
 
As I was trained, you always try for an OPA first, then NPA if the OPA doesn't work.
 
What is the reason for putting in a NPA or OPA. Is the airway compromised? If my patient is breathing-unresponsive, most of the time I will drop an NPA, if I am going to have to bag the patient, than an OPA. Also OPA if my patient has snoring respiration or if i have had to do a jaw thrust or head tilt chin lift to open the airway so the patients can breath on his own. (As long as there is no gag reflex)

It is a case by case basis on which one I use first.
 
NPA to check for responsiveness on a possible drunk case to see if they are faking or if you do not stay awake on me.
 
COtoWestAfricaMEDIC said:
NPA to check for responsiveness on a possible drunk case to see if they are faking or if you do not stay awake on me.
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That's punitive medicine and absolutely inappropriate.
 
Sorry, my sarcasm meter sucks late at night.
 
That's one thing that sucks about texting, typing or interacting in forums like this as you can't tell if some on is for real or is joking around. I guess I can start using the simile face deals.
 
COtoWestAfricaMEDIC said:
That's one thing that sucks about texting, typing or interacting in forums like this as you can't tell if some on is for real or is joking around. I guess I can start using the simile face deals.
Click to expand...
The smile faces do help some regarding that lol :)
 
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