Securing a Nasopharyngeal Airway (NPA)

VentMonkey said:
Regardless, how is this relevant to proper airway management techniques?
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Sorry? I haven't had a patient needing airway management that needed an npa.
Is there an issue with that?

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ResQchick said:
I'm still in the field, and quite active. We just don't get patients requiring an npa as opposed to an opa.
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ResQchick said:
Sorry? I haven't had a patient needing airway management that needed an npa.
Is there an issue with that?
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I'll just leave this here then:
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The NPA is my go to. If I think they may not be able to control their own airway they get one.

The true test of unconsciousness.

At least once a week I drop an NPA.


Perhaps in 19 years you've just never recognized the patient needed one. It takes 30 seconds from recognizing a potential for airway compromise to insertion, so being 5 minutes from an ER is irrelevant.

Or perhaps you're really just not getting any true emergencies, in which case you'd be the whitest cloud I've ever heard of.
 
Put another way, if they didn't wake up screaming and rip it out... they needed it.
 
SandpitMedic said:
Perhaps in 19 years you've just never recognized the patient needed one. It takes 30 seconds from recognizing a potential for airway compromise to insertion, so being 5 minutes from an ER is irrelevant.

Or perhaps you're really just not getting any true emergencies, in which case you'd be the whitest cloud I've ever heard of.
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This was my thought. Probably one NPA a week for me.
 
I don’t get to place very many NPAs. I think for the 2 years I have been a medic I have placed maybe 4. I haven’t really had any patients who would have benefited from it. Either my patients will tolerate an OPA or they are with it enough to not tolerate an NPA.
 
@ResQchick your posts elude to a serious misunderstanding of basic airway management.

Am I off base? I don't know, I'm only going off of a string off posts. One of which makes mention of being 5 minutes from a receiving, and that doesn't seem to quite grasp how relevant an NPA can be in the face of many lethargic, and/ or semi-conscious patients.

I'm shy 4 years of your experience, but have experienced differently nonetheless. I can be anywhere from 5 minutes away from a receiving to an hour away, and yet still can't fathom how learning the ongoing concepts that entail airway management front to back, top to bottom, basic to advanced would not yield a more engaging response.
 
VentMonkey said:
@ResQchick your posts elude to a serious misunderstanding of basic airway management.

Am I off base? I don't know, I'm only going off of a string off posts. One of which makes mention of being 5 minutes from a receiving, and that doesn't seem to quite grasp how relevant an NPA can be in the face of many lethargic, and/ or semi-conscious patients.

I'm shy 4 years of your experience, but have experienced differently nonetheless. I can be anywhere from 5 minutes away from a receiving to an hour away, and yet still can't fathom how learning the ongoing concepts that entail airway management front to back, top to bottom, basic to advanced would not yield a more engaging response.
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Then I'm guessing I am in a whole department of sadly lacking personnel. According to you.
I sincerely hope that when I finish my cc course I understand airway management and am able to tube someone.
I winery how my patients have all survived without my sticking a rubber tube up their noses. Lol.
My colleagues and myself might need further training.
But seriously, I've had no semi conscious patients that needed one. Am I a white cloud? Not really. We just haven't found a huge need for that type of airway management I suppose. I'm going to have to poll the 3 departments I ride with.


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ResQchick said:
I sincerely hope that when I finish my cc course I understand airway management and am able to tube someone.
I winery how my patients have all survived without my sticking a rubber tube up their noses. Lol.
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I think this sums up the point. Airway management is not just the ability to intubate someone. And a CC course is not going to make you an airway expert, nor a expert at critical care for that matter. Don't try to downplay the importance of NPAs just because all your patients "survived without them"!!
 
ResQchick said:
Then I'm guessing I am in a whole department of sadly lacking personnel. According to you.
I sincerely hope that when I finish my cc course I understand airway management and am able to tube someone.
I winery how my patients have all survived without my sticking a rubber tube up their noses. Lol.
My colleagues and myself might need further training.
But seriously, I've had no semi conscious patients that needed one. Am I a white cloud? Not really. We just haven't found a huge need for that type of airway management I suppose. I'm going to have to poll the 3 departments I ride with.


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You've never had to bag a semi conscious patient? You've never bagged a stroke or an OD?
 
NomadicMedic said:
You've never had to bag a semi conscious patient? You've never bagged a stroke or an OD?
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I have bagged in both those situations. Many times. Without an npa. But most times if a person was satting low, an nrb with high flow worked well. I understand your need for one, I also understand that I've had no obvious need or I would have used one.


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ResQchick said:
I have bagged in both those situations. Many times. Without an npa.
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Please tell us you used an OPA then?
ResQchick said:
most times if a person was satting low, an nrb with high flow worked well.
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Again, you have much to learn. And if all three of your departments feel the same as you, then so do they.
ResQchick said:
I understand your need for one.
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No, clearly you do not. Good luck on your "CC" (cardiac tech?) course.
 
VentMonkey said:
Please tell us you used an OPA then?

Again, you have much to learn. And if all three of your departments feel the same as you, then so do they.

No, clearly you do not. Good luck on your "CC" (cardiac tech?) course.
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I'll let our medics know that you think they also need more training. Most of them also work in the city, so I'm certain they'll hop on your advice.
I think I'm doing just fine. But if I ever move to wherever you're from, I'll be certain to brush up.
 
ResQchick said:
I have bagged in both those situations. Many times. Without an npa. But most times if a person was satting low, an nrb with high flow worked well. I understand your need for one, I also understand that I've had no obvious need or I would have used one.


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As the man said, you are certainly lacking in the department of basic airway management.

I apologize for the dogpile, and am not intending to insult your abilities.

Perhaps you can use this for a learning tool as the forum title indicates.

A study was done a few years ago that indicated the single most misunderstood and under utilized intervention in airway management was the head-tilt-chin-lift. This was at all provider levels from basics to medics.

I can see that had the study continued, the use of NPAs (adjuncts in general) would be a close second place.
 
An NPA is a simple BLS measure to ensure the airway is open. It is very very easy to apply, and once it's there you can continue your assessment and other treatments.

If the patient tolerates it, then clearly it is of benefit to the patient. Seeing as how you won't realize their airway is occluded until you notice changes in their presentation or vitals, in which case you are behind a very simple and preventable eightball, so to speak. Especially considering what we know now about the detriments of even a single event of hypoxia in some patients.
 
With the prevalence of opiate overdoses, I don't see how they wouldn't be used on a somewhat regular basis. Hell, I prefer them with things I can immediately fix just because I hate dealing with vomit. Not a fan of messing with gag reflexes....
 
ResQchick said:
I'll let our medics know that you think they also need more training. Most of them also work in the city, so I'm certain they'll hop on your advice.
I think I'm doing just fine. But if I ever move to wherever you're from, I'll be certain to brush up.
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Probably a good idea. Prehospital medicine has advanced quite a bit since you started in the field. Might not be a bad idea to pick up a book every now and again.

FWIW, your hypoxic patients would probably also appreciate you brushing up on airway management.
 
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