Use of NPA on ALOC patient?

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TimRaven

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Hi, I got some problem on the timing of NPA for ALOC patient...

Last week we had a patient with suspect overdose, the pt was only responsive to very strong pain stimulation. Since the pt was supine on the floor, I attempted a NPA to protect her airway after checking facial trauma, but was rejected when pt attempted to pushed my hand away in the process.

Later I was told by my superior that my decision of NPA was inappropriate on this patient, and also told that I can't use NPA on a "responsive to pain" patient per California protocol.

Is this true? I should only use NPA on completely unresponsive patients?
I remember in school yjr only contraindication of NPA was facial/head trauma.
 
I can't speak to your protocols, but typically, as an airway adjunct for the conscious/semi-conscious patient, the NPA is considered perfectly acceptable. In the context of an OD, no reason not to drop one, barring (again) facial trauma (though slight facial traima isn't an absolute contraindication that we have been told: http://m.emj.bmj.com/content/22/6/394.full).
 
I don't know about California protocols but that's not correct. You can use npas on pts who remain responsive to pain.
 
There is no statewide California protocol that I'm aware of. You use any airway adjunct on patients that have some kind of airway compromise. If the "responsive to pain" patient can't control their airway well, you use an airway adjunct.
 
That's what I thought and taught, but my superior clearly doesn't agree.
I should be more careful about their standard in the future...
 
It's a tough situation. Your supervisor clearly needs some re-education but you also don't want to kick your own legs out from under you by seeming argumentative or arrogant. Perhaps you could respectfully show him/her some relevant information and ask whether there might be some misunderstanding? The sad truth is that many EMS providers practice a strange form of care based on superstition, "how it's always been done", and/or simple ignorance.
 
I didn't plan to confront about this issue further anyway. I just want to know if I was mistaken on the airways criteria.
 
Your superior is uninformed at best, and the protocol, if that is actually a protocol, is just plain stupid. Stick anything in your nose - it's irritating as hell - but once it's there, it's not that bad. Think of NG tubes that stay in for days on end. That's why NPAs can be used on conscious or semi conscious patients. Unlike oral airways, they don't stimulate a gag reflex.
 
If the patient can lift their hand and pull out/block the NPA, that's a pretty good sign that they don't need it yet. Did you try bagging without it?
 
Underoath87 said:
If the patient can lift their hand and pull out/block the NPA, that's a pretty good sign that they don't need it yet. Did you try bagging without it?
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I disagree, just because they may have some motor response does not mean they can sufficiently protect their own airway. Any patient who cant protect their own airway should at least consider an NPA. We use the quite regularly in my service, it has become the frontline airway adjunct. the OPAs collect dust
 
Bullets said:
I disagree, just because they may have some motor response does not mean they can sufficiently protect their own airway. Any patient who cant protect their own airway should at least consider an NPA. We use the quite regularly in my service, it has become the frontline airway adjunct. the OPAs collect dust
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An NPA provides no airway protection whatsoever - it simply provides a route for ventilation. If someone is exchanging air just fine, they don't need an NPA.
 
TimRaven said:
That's what I thought and taught, but my superior clearly doesn't agree.
I should be more careful about their standard in the future...
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Little late but check your county protocols? There's no California state wide protocol for anything. Protocols vary from county to county.
 
Remi said:
An NPA provides no airway protection whatsoever - it simply provides a route for ventilation. If someone is exchanging air just fine, they don't need an NPA.
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Agreed. If this pt required airway protection then they should be intubated.
 
I use NPA's a lot more than my coworkers do. Basically, if anyone who is semi-conscious or unconscious will easily accept one but still have a gag-reflex, I always try to drop an NPA on them. If they become combative or just resist the procedure strongly, then I do not go forward with it.
 
Most of my NPA's go in the mouth. Less stimulating than either an OPA or an NPA placed nasally.
 
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Remi said:
Most of my NPA's go in the mouth. Less stimulating than either an OPA or an NPA places nasally.
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Can you elaborate?
 
Standard approach for ETOH patients. NPA x 2 + OPA. Patent the **** out of that airway!
 
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