Eh....it's actually mostly indicated, and has WAY less potential to harm than ammonia. I've used them extensively as a way to check responsiveness.
OPA or NPA?
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NomadicMedic
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People still have ammonia around?
And a trap squeeze is easier than an NPA. If they want to be "unresponsive" but they're ventilating without issue, I just leave them alone. I've got no reason to cram a 34fr hose up someone's snout. In my book, that's punitive and inappropriate.
And a trap squeeze is easier than an NPA. If they want to be "unresponsive" but they're ventilating without issue, I just leave them alone. I've got no reason to cram a 34fr hose up someone's snout. In my book, that's punitive and inappropriate.
Gurby
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I've done it on suspected opiate OD's who aren't responding to narcan, have depressed respirations and are in and out of consciousness. I wouldn't use it on an etOH or something, though.
NomadicMedic
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A suspected OD with depressed respirations is certainly a different situation than simply "checking responsiveness" in an "unconscious" person.
Good rule of thumb: Don't use an airway adjunct unless you need to use a tool to manage the patients airway.
Good rule of thumb: Don't use an airway adjunct unless you need to use a tool to manage the patients airway.
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It's not the one's who respond to a trap squeeze or that obviously want to be "unconsciois" I use it on. It's those boderline, possibly legit medical issue patients that MAYBE narcotized ect that I'll pull the trigger on an NPA for.
NomadicMedic
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But that's not what you wrote.
An NPA isn't a tool to check for responsiveness. It's an airway adjunct. If they need assistance with ventilation or you want to assure an airway while you wait for the Narcan to kick in... Sure. But as a assessment tool? That's pretty sketchy.
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Not as an assessment maneuver per se, but I think its perfectly legit for those "I think this dude might be faking but I'm not sure.....if he really is out of it I want an NPA, and if he's really not out of it, I'll know as soon as I try to place it" situations.
NomadicMedic
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Okay. We'll just agree to disagree on this.
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I don't use airway adjuncts as an assessment tool. I'm going to use my various airway adjuncts because my assessment tells me that the patient needs some kind of airway management because the patient can't manage it effectively on their own.
If the patient is faking well enough, they'll get a surprise when they get that airway adjunct placed...
If the patient is faking well enough, they'll get a surprise when they get that airway adjunct placed...
Where I was doing ride a longs, we have a lot of drunks that "pass out*" and snore so we are required to attempt an opa.
*they would stop responding because we would not speak Spanish to them when they knew English.
If you think an NPA is a reasonable assessment tool, you need to work on your assessment skills. Sorry. The truth hurts.
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Who ever said anything about it being a "reasonable assessment tool"?
There is a big difference between doing an intervention just to what the response is, and doing an intervention because you think it's likely indicated, though you can't be sure.
If you think no one in the field will ever successfully fool you feigning unresponsiveness, then you need to spend some more time in the field. As you gain experience you'll also gain humility.
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DesertMedic66
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This. Every now and then we will get patients who we think are acting however they are doing such a good job that we aren't 100% sure they are faking. Mix that in with snoring respirations and they bought themselves an NPA (after I warn them if they don't wake up a tube is going down their nose).
I don't use it as an assessment tool at all
Sorry - if it quacks like a duck...it's a duck, regardless of what you call it. After nearly 40 years, I know what a duck looks like. There are LOTS of ways to assess an adequate airway and the need (or not) for airway support - and ramming in an NPA because you can't tell whether they're faking it or not is a lousy assessment move.
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Good for you if you are never surprised at someone's willingness to accept an NPA. You win.
Just keep in mind that the OR and the field are very different animals.