OPA with overdose?

TheLocalMedic said:
Why get good ventilation when you can have great ventilation? And having adjuncts really does make a difference and makes suctioning harder. Again, try it out for yourself!
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There fixed it for you haha.

If the airway is patent why play with it?
 
firefite said:
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.
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A matter of preference? If I have a BLS airway that I need to manage, it's pretty common practice here to use both NPAs and an OPA. It really does make life easier. The BLS guys do it without asking in codes.
 
n7lxi said:
A matter of preference? If I have a BLS airway that I need to manage, it's pretty common practice here to use both NPAs and an OPA. It really does make life easier. The BLS guys do it without asking in codes.
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As it should be. I fully expect that when someone is being bagged they get at least one adjunct, and then I ask that they put in at least one more.
 
sleepy said:
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?
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The OPA is not indicated if they have a Gag reflex. If they have OD'd and their breathing is inadequate then use an OPA and begin ventilations, be prepared to suction.

Most OD patients are going to vomit anyways whether you use an OPA or not. The OPA is much faster and easier than an NPA.

Attempt an OPA, if they have a gag or develop one then remove it and use an NPA.

If there breathing is that bad - what do you think the medics are going to do? Most likely they are going to drop a tube. That is a lot more invasive than an OPA.

Bottom line - do what you need to do to ensure a patent airway.
 
In a benzo overdose, depending on how much they've taken, they've already partially performed RSI for me. :) I'll be honest, I've only seen one benzo OD that required airway management, and I just dropped an ET tube. She had no gag and I didn't need any paralytics. Most of the time, when I find them, they're just weepy and sleepy.

I will agree with LEOEMT, if the patient has any gag, but requires a BVM, use an NPA and keep the suction ready. (And I think NPAs are still verboten in King County. It's an OPA or nothing there...)
 
n7lxi said:
In a benzo overdose, depending on how much they've taken, they've already partially performed RSI for me. :) I'll be honest, I've only seen one benzo OD that required airway management, and I just dropped an ET tube. She had no gag and I didn't need any paralytics. Most of the time, when I find them, they're just weepy and sleepy.

I will agree with LEOEMT, if the patient has any gag, but requires a BVM, use an NPA and keep the suction ready. (And I think NPAs are still verboten in King County. It's an OPA or nothing there...)
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You are correct sir - no NPA's here in King County.
 
http://www.emtlife.com/showthread.php?t=16406

This thread pretty much sums up why I've never seen both an OPA and NPA placed together. More specifically the posts made by VentMedic.

Neither the OPA or NPA takes long at all to place. No gag = OPA. If the patient starts to gag it does not take long at all to take the OPA out and insert an NPA.

And the same as what everyone has said about having suction really close by.
 
TheLocalMedic said:
As it should be. I fully expect that when someone is being bagged they get at least one adjunct, and then I ask that they put in at least one more.
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Negative, placing an adjunct in a patient who needs ventilatory assistance but is doing a decent job protecting their airway is taking unneeded risk.
 
usalsfyre said:
:blink:

WHY?!?
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Dunno why. It is BLS at the State level. Why do I get sent to Diabetic emergencies but can't do glucometry when I get on scene - Have to call ALS to do a finger stick for me.

I would assume that the thinking is something along the lines that airway should be evaluated by ALS.
 
leoemt said:
The OPA is not indicated if they have a Gag reflex. If they have OD'd and their breathing is inadequate then use an OPA and begin ventilations, be prepared to suction.

Most OD patients are going to vomit anyways whether you use an OPA or not. The OPA is much faster and easier than an NPA.

Attempt an OPA, if they have a gag or develop one then remove it and use an NPA.

If there breathing is that bad - what do you think the medics are going to do? Most likely they are going to drop a tube. That is a lot more invasive than an OPA.

Bottom line - do what you need to do to ensure a patent airway.
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Fully agree.

To even get a patient to accept an OPA, they have to be out cold and then some. Odds are if its second to an overdose their respiratory status needs assistance at that point and they probably vomited already or will soon.

The job of an OPA and an NPA is to prevent the soft palate and tongue from obstructing the airway. They DO NOT in any way prevent vomiting which is the primary risk factor (for us EMS folk) of most of our overdosed patients that can't be fixed with some narcan.

It is extremely important to reduce risk of aspiration for that patient should they vomit. Sitting them up or putting them in a recumbent position or a little of both holds great value.
 
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firefite said:
http://www.emtlife.com/showthread.php?t=16406

This thread pretty much sums up why I've never seen both an OPA and NPA placed together. More specifically the posts made by VentMedic.

Neither the OPA or NPA takes long at all to place. No gag = OPA. If the patient starts to gag it does not take long at all to take the OPA out and insert an NPA.

And the same as what everyone has said about having suction really close by.
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I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best. Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier. Why conform to a "if a doesn't work try b" approach when you can have a, b and c?
 
TheLocalMedic said:
Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier
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I heard about this a while ago and it was called the "Hedgehog look"; made me laugh.

Nothing wrong per-se with using an OPA in this patient, I would probably use a nasal airway and roll them on their side.
 
TheLocalMedic said:
I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best. Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier. Why conform to a "if a doesn't work try b" approach when you can have a, b and c?
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Why would you spend that much time with airway adjuncts when you could be bagging them.
 
Achilles said:
Why would you spend that much time with airway adjuncts when you could be bagging them.
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Because if you have a patent airway it makes ventilation much easier and means you do not have to sit there giving somebody an active jaw thrust for the entire journey to hospital.
 
TheLocalMedic said:
I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best. Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier. Why conform to a "if a doesn't work try b" approach when you can have a, b and c?
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Or you can just give the patient a patent airway with an OPA or a NPA and then move on to bagging the patient and moving on with the assessment and treatments.

Once you get a patent airway is there really a need to make sure it's "super patent" by shoving more things down their oral/naso pharynx?
 
TheLocalMedic said:
I've read that thread, but still remain convinced that the "more is better" approach to BLS airways is best. Argue theoreticals all you want, but I can say, having tried it both ways, that having an OPA and two NPAs does in fact make your ventilation easier. Why conform to a "if a doesn't work try b" approach when you can have a, b and c?
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How exactly have you determined that this method is more effective? Saying "it's better cause I say so" is worse than arguing the "theoreticals."

Also in the few BLS airways I've had, all required constant positioning of the jaw and head to maintain effective ventilation even with an adjunct.
 
Clare said:
Because if you have a patent airway it makes ventilation much easier and means you do not have to sit there giving somebody an active jaw thrust for the entire journey to hospital.
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Why not just use a king?
 
The "because I say so" bit only comes from having heard about it, tried it, and had it work well. I did a side by side comparison on several patients, first bagging them with just an OPA or NPA and then with an additional adjunct or two. There is a noticeable difference. Granted, positioning is a crucial and often overlooked aspect of ventilation in the prehospital setting, so that's a must as well.
 
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