Securing a Nasopharyngeal Airway (NPA)

[VentMonkey]

I'll let our medics know that you think they also need more training.

Please do, it will benefit the patient population you all serve, and not appease your egos.

Most of them also work in the city, so I'm certain they'll hop on your advice.

I haven't a clue what this even means. Either way, people such as yourself are a prime example why prehospital providers do not deserve the right, or privilege to continue to intubate people outside of a hospital setting.

I've fed you a 12-course meals worth, I'm done here.

 

[Qulevrius]

This is my 1st time ever seeing Monkeh going ape...


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[DesertMedic66]

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....

Opiate ODs are pretty rare in my my neck of the woods. I don’t remember the last time I have even heard of a crew having one let alone one of my own.

 

[VentMonkey]

This is my 1st time ever seeing Monkey going ape...

"Just when I think I'm out..."

Long story short, we're talking one of the subjects I enjoy and pride myself on most: airway management.

When you can't comprehend the basics, what makes you worthy of advanced management, and all of their responsibilities?

 

[Qulevrius]

"Just when I think I'm out..."

Long story short, we're talking one of the subjects I enjoy and pride myself on most: airway management.

When you can't comprehend the basics, what makes you worthy of advanced management, and all of their responsibilities?

I know exactly where you're coming from. I feel the same way about pathogens, and when people start spewing nonsense, it hurts. Physically.


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[DrParasite]

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.

Based on the fact that your in cc class, and most of your medics works in the city, I'm guessing your an NYS EMT living on long island?

You should let them know, they will probably tell you that NPAs have their roles, and if you aren't dropping one, you are doing your patient a disservice.

I think I'm doing just fine. But if I ever move to wherever you're from, I'll be certain to brush up.

Well, as long as you think your doing fine, I guess that pretty much shows how open minded you are to the current standards of prehospital medicine...

BTW, I know many people who work EMS in the city, and they think they are the best at everything, an opinion that is shared by nobody else.........

 

[StCEMT]

Haven't even had it come up with Coachella and all that mess?

 

[DesertMedic66]

Haven't even had it come up with Coachella and all that mess?

That is really the only time that I ever need to use NPAs.

 

[E tank]

I have to say that, IME, if an NPA will work for a patient, so will a head tilt/ jaw lift/thrust. It provides a more "hands free" situation and doesn't mean the difference between having an airway or not. I can't personally say that about an OPA. If a patient really needs one to maintain his airway or to make mask ventilation possible, nothing else will do. There are those situations where either or might work, but there are definitely those times when only an OPA will work.

So folks not ever having used one or used them extremely rarely doesn't surprise me at all. They're more of a finesse type of device, IME.

 

[ThadeusJ]

I used OPA's far more than NPA's and almost (almost) was at the point where I thought that NPA's were just another piece of equipment that was cluttering up the airway bag...until I had a patient with trismus that needed suctioning...thought to myself, "Huh, now where did I put that NPA thingy?"

For context, one of the anecdotes did occur on a patient where I worked and another occurred to a colleague in a service far, far away, so I consider the occurrences verified. Also, the one that happened closer to home had the very confused patient fire it back into the airway themselves when left unattended.

Thanks everyone for their feedback.

 

[Carlos Danger]

Basic adjuncts were never emphasized during my initial paramedic training or any of my continuing education, so unfortunately I just never got in the habit of using them. I used OPA's occasionally (probably not nearly as often as I should have), but I honestly don't know if I ever placed a NPA in the field. It seems that nowadays since we have so much easier access to information, many paramedics are more aware of and accepting of the idea of managing the airway rather than just intubating everyone as soon as possible, and so are generally more comfortable (or at least familiar) with a wider range of techniques, including the use of basic adjuncts.

So, I wouldn't agree that never having used a NPA in the field necessarily indicates a lack of experience, or poor judgement. But I would say that the "we've always done it this way, so I know we are right" attitude that we are all to familiar with is apparently alive and well.

 

[GMCmedic]

I think Ive been turned off of NPAs. When I was a new EMT, I thought it was super cool when my Medic partners asked me to stick an NPA in a drunk guys nose. Now that I have more time and experience I realize that was just them being a ****.

I probably should get in the habit of using them during RSI, mainly when I have a firefighter bagging. With passive oxygenation, I really ever think about them.

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[NomadicMedic]

Anyone who's altered enough that I'd even think about airway management gets an NPA right off the bat. ODs and strokes especially.
I may move further down the airway pathway or I might pull it.

I think not using an NPA (or an OPA if tolerated) in a case where you're providing airway management is lazy.

 

[VentMonkey]

I think not using an NPA (or an OPA if tolerated) in a case where you're providing airway management is lazy.

And in some providers cases, it shows lack of fundamentals. I'm not saying everyone semi-comatose has gotten one, and I like that the even more advanced-than-paramedic providers on this forum make mention of head-tilt chin lifts.This shows...(drumroll please)...fundamentals.

If you can't comprehend every airway technique from start to finish then by all means stay away from said patients airway, you are not entitled to that privilege. "I get to (got the) tube" is old, foolish, dangerous, and has no place in clinical practice; prehospital, or otherwise.

 

[SandpitMedic]

I don't even know why this is a debate. It's on the damn NREMT psychomotor exam checklist under airway. (Not the infallible end-all-be-all, I know). It's there for a reason. Maybe if instructors wouldn't let candidates "verbalize" everything...

For crying out loud, it's not the only way to skin a cat, but some of you guys are acting like it's some alien device or just taking up space in the airway roll? Placing an NPA was a punitive move, you assumed, so now you never use them?

**** man, no wonder taking away intubation is on the table... we can't even get a group of like minded EMS professionals, who are in a group that gives enough ****s to be on an online education forum, to agree that the use of a NPA is probably a good idea in basic airway management.

I realize I might not be making many friends in this thread, but this is a BLS technique and in most cases works better than an OPA (no puke , allows for passive O2/preoxygenation, doesn't get in the way of intubation, etc.)
Sheesh, you should be using two to allow passive oxygenation prior to and during intubation on unconscious or sedated airway patients.

I would encourage anyone doubting the validity or constructive use of the NPA to use one this week if they get any patient that might tolerate it. Just... try the damn thing.