OPA with overdose?

[sleepy]

I'm studying for NREMT. This sample question says your patient overdosed on Valium and is unconscious. Their answer is to put him in lateral recumbent position to protect his airway, instead of inserting an OPA which I thought was correct. I know you don't insert OPA when something like drain cleaner was ingested, but you avoid it for pills too? Doesn't make sense to me. Or what is their reason?

 

[feldy]

with an OD, i wouldnt use an OPA, i would go with the NPA because of the high chance that if pt. wakes up then they are gonna vomit and as long as youre not assisting ventilations go with latteral recumbant.

 

[mycrofft]

Ten points

Rule of thumb is do the most with the least chance of harm.
Rule of Exam: say what they want and ask on EMTLIFE what they mean.

IF trismus is a potential (not with a benzodiazepine like Valium), then yeah, get an OPA in. Otherwise, suction and ventilation can be a problem.

 

[Porkchop]

with an OD, i wouldnt use an OPA, i would go with the NPA because of the high chance that if pt. wakes up then they are gonna vomit and as long as youre not assisting ventilations go with latteral recumbant.

+1. In EMT school, I was taught never to use an OPA with an overdose.

 

[BLSBoy]

+1. In EMT school, I was taught never to use an OPA with an overdose.

Never say never....

 

[mycrofft]

We had a mixed OD (Elavil, Neurontin, and whatever else he could get)..

Wished we could have gotten an OPA in place (we don't have tubes) before trismus set in and he was drooling. Snaked a Yankauer tip in one buccal side and turned him in that side, but it mostly wanted to suck off his buccal mucosa, not the slime.

 

[MrBrown]

If somebody has OD'd on benzos the only thing I wouldn't be using is flumazinil!

Don't see the reason not to use an OPA if they wake up and don't tolerate it take it out, if the throw up, take it out.

 

[VentMedic]

If somebody has OD'd on benzos the only thing I wouldn't be using is flumazinil!

Don't see the reason not to use an OPA if they wake up and don't tolerate it take it out, if the throw up, take it out.

The thing about an OPA, unless you are actively managing that airway, the OPA can become an obstruction. How many times when using a BVM have you had to pause briefly to readjust the OPA?

If they throw up with the OPA in place, they have aspirated. The preferred would be to not cause vomiting until patient and airway are in good position with easy access.

 

[MrBrown]

Couldn't we say the same for anybody who has is unconscious and gets an OPA, they are all at risk of vomiting.

 

[VentMedic]

Couldn't we say the same for anybody who has is unconscious and gets an OPA, they are all at risk of vomiting.

If you are using a BVM and have control over the airway, your eyes will be on that patient and you should have suction available. I have seen patients brought in with an OPA and on a NRBM without anybody watching the airway and the mouth full of vomit. If you are using an OPA and/or the BVM, you should have suction nearby, really nearby. Occasionally the patient wakes up somewhere between the ambulance and the ED bed where to get to suction in either direction is a scramble.

 

[Shishkabob]

with an OD, i wouldnt use an OPA, i would go with the NPA because of the high chance that if pt. wakes up then they are gonna vomit and as long as youre not assisting ventilations go with latteral recumbant.

Waking up has nothing to do with someone vomiting when something is in their mouth. It has to do with someone having an intact gag reflex. If they don't have a gag reflex, you're probably good to go.

You'll often see an OPA used in the OR, and someone will most likely wake up much more quickly from a Propofol dosing than from a Valium overdose.

 

[VentMedic]

You'll often see an OPA used in the OR, and someone will most likely wake up much more quickly from a Propofol dosing than from a Valium overdose.

There is a reason we use Propofol and it is so they do not wake up until we are ready for them to do so. That would be a disaster on some forms of ventilation and during some procedures. That is why Propofol is the drug of choice. For the Valium OD, do you know how much the patient took? You do know the dosing for Propofol. If the patient is in the OR they probably have been given a paralytic and are on an ETCO2 monitor to know when there is diaphragm action to indicate the patient is waking.

 

[John E]

Hmmm...

was the patient breathing in the scenario?

Lots of people putting the cart before the horse.

John E

 

[WallabyWalrus]

I'm studying for NREMT. This sample question says your patient overdosed on Valium and is unconscious. Their answer is to put him in lateral recumbent position to protect his airway, instead of inserting an OPA which I thought was correct. I know you don't insert OPA when something like drain cleaner was ingested, but you avoid it for pills too? Doesn't make sense to me. Or what is their reason?

I don't understand? put a dose of Flumazenil into his vein and watch him wake up instantly and be standing by with another dose of any kind of IV Benzo in case he is dependent upon benzo's. As Flumazenil can cause the patient to start having a seizure if pt is SEVERELY addicted. so on 2nd thought maybe not such a good idea unless you know patients background...

Its kind of like an opiate OD and how narcan effects the patients. If you give an opiate addict a huge IV dose of naloxone he/she will usually wake up and immediately start having withdrawal symptoms. :unsure:

 

[STXmedic]

I don't understand? put a dose of Flumazenil into his vein and watch him wake up instantly and be standing by with another dose of any kind of IV Benzo in case he is dependent upon benzo's. As Flumazenil can cause the patient to start having a seizure if pt is SEVERELY addicted. so on 2nd thought maybe not such a good idea unless you know patients background...

Its kind of like an opiate OD and how narcan effects the patients. If you give an opiate addict a huge IV dose of naloxone he/she will usually wake up and immediately start having withdrawal symptoms. :unsure:

Holy necro-thread!

You carry flumazenil where you work? Hell, most doctors I know don't even mess with flumazenil anymore. Have fun controlling that seizure with that on board... Why not just ensure adequate oxygenation and cruise in nice and chill to the hospital?

 

[TheLocalMedic]

I'm a big fan of the "more is better" approach to BLS airway management. Until such time as you are able to get a tube, you will be doing yourself a huge favor and making your ventilations easier by dropping not only an OPA but an NPA in each nostril as well. What? Three BLS adjuncts? That's right, THREE! Granted, it's a little unconventional, but I think that the logic speaks for itself on this one if you think about it.

And so you pop in an OPA and the pt starts to gag or vomit? Just pull it out, roll 'em and suction really well. Oh, and BAM! You've still got two NPAs in place to boot!

 

[DesertMedic66]

I'm a big fan of the "more is better" approach to BLS airway management. Until such time as you are able to get a tube, you will be doing yourself a huge favor and making your ventilations easier by dropping not only an OPA but an NPA in each nostril as well. What? Three BLS adjuncts? That's right, THREE! Granted, it's a little unconventional, but I think that the logic speaks for itself on this one if you think about it.

And so you pop in an OPA and the pt starts to gag or vomit? Just pull it out, roll 'em and suction really well. Oh, and BAM! You've still got two NPAs in place to boot!

I don't really see the need for NPAs plus an OPA. The job of the OPA and NPA are to keep the tongue off the back of the throat. That can and most of the time is easily achieved with just using one of the BLS adjuncts.

 

[TheLocalMedic]

I don't really see the need for NPAs plus an OPA. The job of the OPA and NPA are to keep the tongue off the back of the throat. That can and most of the time is easily achieved with just using one of the BLS adjuncts.

Yeah, but if you have an issue with one of you adjuncts, you can pull it an still have other adjuncts already in place. And it really does make ventilation easier. I recommend you try it a few times so you can see the difference!

 

[Achilles]

If you're getting good ventilationa with out an OPA or npa why even put one in?

 

[TheLocalMedic]

Why get good ventilation when you can have great ventilation? And having adjuncts really does make a difference and makes suctioning easier. Again, try it out for yourself!