OPA with overdose?

[Clare]

Why not just use a king?

You could use an LMA but I think that's a bit of overkill for overdose patient with an altered level of consciousness but still spontaneously breathing

If they are very deeply unconscious and have inadequate breathing then an LMA is appropriate.

 

[STXmedic]

You could use an LMA but I think that's a bit of overkill for overdose patient with an altered level of consciousness but still spontaneously breathing

If they are very deeply unconscious and have inadequate breathing then an LMA is appropriate.

Just out of curiosity and fairly irrelevant to the discussion, but I'm assuming you aren't from the US?

 

[Clare]

Just out of curiosity and fairly irrelevant to the discussion, but I'm assuming you aren't from the US?

Your assumption is correct. Do my words have a foreign sound to them or something?

The LMA is great for patients who are unconscious and poorly oxygenated +/- spontaneously breathing. If a patient just has an altered level of consciousness be it from a traumatic brain injury, overdose, poisoning, stroke or whatever and is spontaneously breathing adequately I don't think an LMA is indicated; if they have inadequate oxygenation or are difficult to ventilate with just an oral airway then an LMA will do the trick.

 

[Aidey]

Your assumption is correct. Do my words have a foreign sound to them or something?
.

You've used British English spelling several times.

 

[STXmedic]

Your assumption is correct. Do my words have a foreign sound to them or something?

The LMA is great for patients who are unconscious and poorly oxygenated +/- spontaneously breathing. If a patient just has an altered level of consciousness be it from a traumatic brain injury, overdose, poisoning, stroke or whatever and is spontaneously breathing adequately I don't think an LMA is indicated; if they have inadequate oxygenation or are difficult to ventilate with just an oral airway then an LMA will do the trick.

In the states we call GTN NTG Also, most places here do not carry/use LMAs. King tubes are by far the most common BIAD, though I'm sure there are still some combi tubes and LMAs floating around somewhere.

To try and be somewhat on topic:
If the patient has spontaneous, adequate respirations with no airway compromise, of course they don't need a tube (whatever your tube of choice). Maybe an NPA if anything, and let them be.

Once you start having to drop an OPA, hold a jaw thrust and bag them, then they'll probably buy some form of tube. And no, not a moot point on Kings. MANY areas consider a King tube a BLS airway. It is by no means uncommon.

In regards to multiple airway adjuncts, I've seen the "hedgehog" face (?) before, don't think I'm sold on it. If I can get an OPA, awesome. A single NPA along with it is nice if they're likely to get intubated (in case there's a missed tube, they still have an adjunct in). I really don't see the need to drop an OPA and two NPAs, though... Like firefite said, if you can secure a good and patent airway, why do you need a super-duper good one. More is not always more.

 

[Clare]

You've used British English spelling several times.

Please excuse me while I fetch tea and crumpets ....

If the patient has spontaneous, adequate respirations with no airway compromise, of course they don't need a tube (whatever your tube of choice). Maybe an NPA if anything, and let them be.

I agree that an NPA and lateral positioning for a patient who is spontaneously breathing but is unconscious or has an altered level of consciousness is most likely all that is required.

Once you start having to drop an OPA, hold a jaw thrust and bag them, then they'll probably buy some form of tube. And no, not a moot point on Kings. MANY areas consider a King tube a BLS airway. It is by no means uncommon.

It depends; I think for patients who require a bit more airway intervention but are close to hospital (< 15 min) or who do not have very poor oxygenation then an OPA is appropriate. For somebody who is in respiratory arrest, very poorly oxygenated or who is more distant from hospital then an LMA is a good idea.

From memory the average number of insertions per year per person is two or three and this seems fairly correct.

The LMA is great, it's cheap and works reasonably well for what it was intended for. It is an ideal middle point between a supraglottic airway and intubation, it is easy to insert and an easy skill to keep up. They've been around for a number of years now, first appearing somewhere between 2003 and 2007, and are very much here to stay. There has also been a big push to not intubate people if an LMA is in place, working well and the patient is reasonably close to hospital (< 15 min). RSI is an exception to this of course.

 

[WallabyWalrus]

But still I don't understand why you guys don't have a a GABA antagonist like Flumazenil or something? That would be the best way to reverse all the symptoms of an OD.. But honestly its really hard to OD on accident on benzo's, so basically if you see someone OD'd on a benzo its most likely a suicide attempt which means they took a ridiculous high dose which would require a GABA antagonist anyways once they arrive at hospital... But yeah I doubt hardly any of you guys have even come across a benzo OD sense its not like barbs which were a lot easier to OD on, but benzo's replaced those way way back in the day (like in the 80's).. :unsure:

 

[Achilles]

It reverses the symptoms?

 

[usalsfyre]

But still I don't understand why you guys don't have a a GABA antagonist like Flumazenil or something? That would be the best way to reverse all the symptoms of an OD..

Except they have a nasty tendency to have status seizure that are refractory to ANY treatment (not just benzos) after Romazicon.

But honestly its really hard to OD on accident on benzo's, so basically if you see someone OD'd on a benzo its most likely a suicide attempt which means they took a ridiculous high dose which would require a GABA antagonist anyways once they arrive at hospital... But yeah I doubt hardly any of you guys have even come across a benzo OD sense its not like barbs which were a lot easier to OD on, but benzo's replaced those way way back in the day (like in the 80's).. :unsure:

You very, very rarely see a true benzo overdose due to the fact it has indirect action. Usually its a polypharm/alcohol issue. Which is why its far safer to ventilate/tube them and wait it out than to start reversing stuff.

 

[WallabyWalrus]

^^ Yeah that is very true... you are very right... Oh well I was just thinking of why EMT's don't carry much more meds then they do. Oh well..:wacko:

 

[NYMedic828]

^^ Yeah that is very true... you are very right... Oh well I was just thinking of why EMT's don't carry much more meds then they do. Oh well..:wacko:

Because then they would just be a paramedic

 

[Achilles]

Because then they would just be a paramedic

Lol I like that.

 

[Aidey]

Except they have a nasty tendency to have status seizure that are refractory to ANY treatment (not just benzos) after Romazicon.

In all the times I've followed up on my benzo ODs I've never heard of a hospital giving it. Depending on which benzo and how much the patient either gets tubed for a day or two or monitored.

 

[abckidsmom]

In all the times I've followed up on my benzo ODs I've never heard of a hospital giving it. Depending on which benzo and how much the patient either gets tubed for a day or two or monitored.

Me too. We have one toxicology attending who loves when they OD on benzos on top of whatever else because then at least they just sleep it off.

 

[phideux]

was the patient breathing in the scenario?

Lots of people putting the cart before the horse.

John E

Bingo!!!! Unconscious does not mean not breathing adequately, or an airway that is not patent. No info about the airway status in the Original Post. I'm not in the habit of just dropping in an OPA in an OD.

 

[Achilles]

Bingo!!!! Unconscious does not mean not breathing adequately, or an airway that is not patent. No info about the airway status in the Original Post. I'm not in the habit of just dropping in an OPA in an OD.

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

 

[lightsandsirens5]

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V-Tach?

 

[Clare]

V-Tach?

Looks like VT to me

 

[Achilles]

V-Tach?

:rofl: I lol'ed :rofl: SVT

Looks like VT to me

 

[Clare]

:rofl: I lol'ed :rofl: SVT

Needs a shorter QRS duration to be SVT