Hey! Do either of you prefer one over the other? I know they are each used in different circumstances... but I don't think I have ever seen an OPA used on a PT before. Probably because they weren't fully clonked out and it may have caused a gag reflex. NPA's just seem so much easier. Have you used both? Are they both pretty easy to insert? I've seen many NPA's inserted and it looks like cake. I know with the OPA you have to twist it 180 degrees and such. Do you prefer one over the other? How do you decide which airway to use?
OPA vs NPA
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DesertMedic66
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Most patients who you can use an OPA on get intubated. They are both easy it place.
Some members on here place both OPA and NPAs in patients and others will just use one or the other. If there is a gag I use NPA. If there is no gag then it's usually OPA followed shortly by king airway or intubation (assuming the patients airway is not patent and the patient is unconscious).
Some members on here place both OPA and NPAs in patients and others will just use one or the other. If there is a gag I use NPA. If there is no gag then it's usually OPA followed shortly by king airway or intubation (assuming the patients airway is not patent and the patient is unconscious).
Gotcha! I kind of figured. Again, there is a chapter in my book on intubation but it says to follow your agencies protocols if you can even assist with them. I know with the fire dept here intubation is an ALS thing. So I was kind of shocked seeing it in my book.
Summit
Critical Crazy
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What Desert said...
FWIW I think NPAs are underutilized.
FWIW I think NPAs are underutilized.
Trailrider
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OPA is great for unconscious bariatric patients, where as ETT isn't not very efficient. You use what is available to you at any given time,but stay in your scope of practice. ETT isn't the be all end all of everything.
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I've watched plenty of NPAs stimulate a gag reflex but I've also watched plenty of them work flawlessly.
They both are useful and work like they're supposed to if they're used when they're indicated and easily inserted. I wouldn't say I prefer one or the other.
Intubation can be a one person thing but its much easier with a helper. It's not uncommon to need someone to hold back upwards and rightwards (BURP) or hold a position after external laryngeal manipulation (ELM) That's why your book talks about assisting rather than performing. There's a lot more to intubating than "Stick the bade in their mouth, lift up and put the tube in the hole."
They both are useful and work like they're supposed to if they're used when they're indicated and easily inserted. I wouldn't say I prefer one or the other.
Intubation can be a one person thing but its much easier with a helper. It's not uncommon to need someone to hold back upwards and rightwards (BURP) or hold a position after external laryngeal manipulation (ELM) That's why your book talks about assisting rather than performing. There's a lot more to intubating than "Stick the bade in their mouth, lift up and put the tube in the hole."
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An NPA shouldn't stimulate a gag reflex. It can stimulate coughing or sneezing, but that is not the same as a gag reflex.
You can place both in the same patient. Heck, you can place 2 NPA's and an OPA, for that matter.
I think both devices are under-utilized.
You can place both in the same patient. Heck, you can place 2 NPA's and an OPA, for that matter.
I think both devices are under-utilized.
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I agree they shouldn't, but like I said I've watched it happen many times, to the point of vomiting not just coughing and sneezing.
xrsm002
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I saw NPAs used more then
OPAs during my rideouts
OPAs during my rideouts
NomadicMedic
I know a guy who knows a guy.
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I tend to grab an OPA for codes and an NPA for everything else.
Trailrider
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I have performed NPAs on manikins in class, but I have never seen the procedure done on car either metro or rural services. It's just one of those handy little things to know may the need arise.
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I put NPAs in frequently. They're very useful, and quite well tolerated most of the time. For me, an OPA is typically a hold-over to intubation. Either I'm using it while ventilating with a BVM on a cardiac arrest or it's a sign that my patient probably doesn't have a gag reflex that will prevent airway control without drugs. I imagine an OPA could be used on a subset of opiate OD patients too that you're ventilating, but I haven't had one of those in forever.
Bullets
Forum Knucklehead
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You guys need to ride with me sometime. I use NPAs pretty much exclusively.
Most of my unconscious patients have had gag reflex. I dont even waste my time with the OPA if they are unconscious, go straight to the NPA.
Huh?
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Try to insert a NPA on yourself.. JMO, but if you can successfully do it on yourself first, it gives you a little more confidence when you do it for the first time on a pt..
And it makes for a fantastic FB video... And bragging rights..
Bullets
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fat tongue and upper airway, lack of neck
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Fat people can be super easy tubes, or it can go the other direction and be a nightmare. Same goes for skinny people honestly. This doesn't affect the "efficiency" of an ETT. In large patients, it's more likely you will need a tube to adequately ventilate the patient due to the problems you mentioned and the weight of the chest. Creating a tight enough seal with a BVM on an obese patient can be a disaster, making ventilations difficult with or without an OPA.
Although I've used both airways many times, my preference for most patients is the NPA as there is far less risk of stimulating the gag-reflex. Unless the person is VSA or presents with conditions that contraindicate the use of an NPA, the NPA is my front line BLS airway (for patients requiring airway management).
As far as ease of insertion, I find the OPAs slightly easier to insert - even if you have to rotate them. The problem with some patients is that their nasal passage may be partially occluded, and as such, an NPA may be difficult to pass. That being said, I don't find this to be a huge issue on the vast majority of calls where I've had to insert an NPA.
Christopher
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Bizarre, OPA's are the least used of the adjuncts by far in our area (urban, suburban, and rural).
I quite frequently double up on NPA's when I place them. Only once have I got with the three-fer OPA+NPAx2, but they needed some serious oropharyngeal soft tissue splinting.
Brandon O
Puzzled by facies
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NPAs are like, oh... thank-you cards.
You maybe never "need" them but if you look for chances to use 'em, they're everywhere.
You maybe never "need" them but if you look for chances to use 'em, they're everywhere.