Questions about Airway

[ADyingBreed]

Hey guys




I have some questions about OPA's. Our intructor never really goes in depth about things, but I know we don't have much class time


Anyways; when we place an OPA we still have to maintain a head tilt chin lift (or jaw thrust)... right? So... what's the point in using them? Isn't that what those techniques do anways? Is get the tongue out of the way? If I'm wrong, please let me know! I like to learn


Secondly, do we use OPA's/NPA's in every unconscious or respiratory arrest patient, as long as they have no gag reflex? If no.. then when do we know when to use them or not?


If you think these questions are dumb, just know I'm still in EMT class. I'd rather know than wonder



Thanks

 

[CPRinProgress]

You are always supposed to use an opa when they are unconscious unless they have a gag reflex then you use a npa. You wouldn't be able to use either if they had a gag reflex and facial or head trauma.
When using an airway you no longer need to hold it open manually.

 

[ADyingBreed]

When using an airway you no longer need to hold it open manually.

So when there's an OPA in, I don't have to continue maintaining a head tilt chin lift, for instance?

 

[Carlos Danger]

So when there's an OPA in, I don't have to continue maintaining a head tilt chin lift, for instance?

It really depends. You will probably still have to lift the chin. It is completely untrue that the presence of an OPA automatically negates the need for a chin lift.

The OPA and chin lift do 2 different things. The OPA simply keeps the tongue from occluding the airway, and the chin lift aligns the oral, pharyngeal, and tracheal axes and gives the air you are forcing in with the BVM a path-of-less-resistance to the trachea, so that it is more likely to go into the lungs than the stomach.

An NPA is always a good idea, in addition to the OPA.

 

[ThadeusJ]

But you do have to ensure a patent airway. Placing an OPA in no way, shape or form guarantees 100% that it is doing what it supposed to be doing (or you think is doing). There have been plenty of times when I have had to do a jaw thrust to maintain a patent airway after placing an OPA. The OPA still acts as a bite block in the event of trismus or if the patient requires suctioning.

If the OPA does what you want it to do, then you don't have to do it.

 

[Brandon O]

Anyways; when we place an OPA we still have to maintain a head tilt chin lift (or jaw thrust)... right? So... what's the point in using them? Isn't that what those techniques do anways? Is get the tongue out of the way? If I'm wrong, please let me know! I like to learn


Secondly, do we use OPA's/NPA's in every unconscious or respiratory arrest patient, as long as they have no gag reflex? If no.. then when do we know when to use them or not?

Very good questions.

The short answer is that you have a variety of methods of holding open the airway, and you should use whichever is most appropriate. At times that means using more than one. There are a lot of soft tissues that can occlude the airway (including the lips, tongue, and soft palate, which an NPA/OPA can help splint open, but others too). Check out these videos for some insight (thanks to Christopher for pointing these out:

http://www.emsworld.com/video/10817087/aw-techniques-x-ray-rotate

http://www.emsworld.com/video/10817090/jaw-thrust

An unconscious person may maintain their own airway (or just need some positioning). They may need some help from an NPA or an OPA or both (or the trifecta). They may need a jaw thrust instead or in addition, which works great and it's always available, but also means you're stuck there at the head. Very difficult airways may need all of the above. And, of course, some people don't necessarily "need" any of this, but you may opt to use it just to make things easier or to ensure they stay that way, which is why you're often taught to toss an OPA into anybody who'll take it.

 

[mycrofft]

Results count.

Whatever it takes to make the chest rise and fall, and you can auscultate lung sounds and not stomach gurgles.

If you get to that stage and you are not mechanically resuscitating, the modified HAINES position may work also. In a multiple-casualty, or if you lack the proper airway, and for whatever reason cannot sit there holding the mandible extended (or the pt starts vomiting while you are sitting there extending the mandible), such a position which allows the tongue and secretions to stay out of the airway due to gravity may be the only thing you have.

Consider the effect trismus or a seizure would have on an oropharyngeal airway, versus a nasopharyngeal.

 

[Brandon O]

If you get to that stage and you are not mechanically resuscitating, the modified HAINES position may work also. In a multiple-casualty, or if you lack the proper airway, and for whatever reason cannot sit there holding the mandible extended (or the pt starts vomiting while you are sitting there extending the mandible), such a position which allows the tongue and secretions to stay out of the airway due to gravity may be the only thing you have.

The venerable "recovery position" is a splendid way of managing an airway. So is sitting someone upright. Really, supine is the very worst way... but it's hard to do things to people in any other position (bag them, for instance).

 

[mycrofft]

The venerable "recovery position" is a splendid way of managing an airway. So is sitting someone upright. Really, supine is the very worst way... but it's hard to do things to people in any other position (bag them, for instance).

Winner winner chicken dinner. If you were here I'd buy you a beer.

I think many of us would need two hands or more to count the times we've seen patients turned supine and their airway shuts down.

 

[Mariemt]

The opa also works splendidly as a tongue blade when you are inserting a king . Since you usually put an opa in first you can use the opa to pull the tongue into the right position as you insert the king.