Good stuff, as always. Just a thought for a future series, you could walk everyone through the TCCC MARCH algorithm by breaking down each skill you need for MARCH skill by skill.
That poor guy on the table started to look a little panicky right before you pulled that garden hose out of his nose 😂. Thank you so much for this video and the actual demo!
20 years an a Flight Medic /Pilot, OUTSTANDING demo, with the poor quality EMT/Medic schools that are going on in todays world students could learn alot from this video!
In my area, they still teach not to insert an NPA when you observe or suspect a head injury. I agree that the NG tube is smaller and would be more likely to find its way through the ethmoid and into the brain vs the larger NPA. But we have to follow medical control and I'm sure you will agree that whatever they says goes and the M.D. behind their name stands for my decision lol.
@@theparaminuteman I thought I read that there were only like 2 documented cases of NPAs. But that might have been the NG tubes. I'd have to look at that study again to be sure.
Fantastic topic and review for some. As you know, another advantage of an NPA over an OPA is that if some form of advanced airway becomes available than one saves a bit of time (yes, minimal) having to remove the OPA. THE NPA could be left in place in a pinch. (1…2…3… argumentative comments begin. lol 😮)
Good video. Kudos to live demo. The lubricated bevel is inserted along the midline because the turbinates attach laterally and with gentle pressure can avoid the complication of epitaxis.
Thank you, Sam. That a very useful and understandable explanation. Especially for me as a not native English speaker, an overlay with subtitles of the specific terms would be nice.
Hello, this channel is one of my favorites for information on this subject and thank you for making such awesome videos. I was curious though, I have sleep apnea and have to use a CPAP machine to sleep at night otherwise there's obstructions, I start snoring and I stop breathing. It's a real problem when we have power outages and I can't use the CPAP. Would this device work for keeping the airway open while I sleep? Assuming the gag reflex isn't a problem of course lol.
Thanks for the great video! Does tilting the head back and pushing the jaw forward do the same thing as an NPA? Or is there something specifically better or different about NPAs? I know that one obvious advantage is that you don’t have to stay at their head maintaining the head tilt/ jaw thrust
Thank you for all your videos.. In an emergency situation if a medic was down to their last NPA, but it was found to be too large for the casualty, is it permitted to cut the tube to size as long as the diameter and curvature of the tube was not a compromising factor??
Very insightful info . So if required to insert on a conscious patient who's had trauma or below 95 on O2 that would be possible to ensure better airflow? Or would you have a tripod them?
awesome videos man, i got some questions. when packing, how do you prevent from pushing the bullet even deeper? and can you talk a bit about TQ removal? thx everyone who responds 😊
Has Brian been to SF scuba, Buds, or MCD? Looks like he’s familiar with shutting down his nasal breathing haha. Great videos. Ive done most of this stuff but these are great refreshers! Spit on it before you stick it in 😊
Had one three weeks ago. I had blood and blood clots in my sinus for two weeks. Practice and practice more all it takes is one hard push and you have another issue to worry about.
Outside of orthopedic surgery, very few medical interventions require high force. If you find yourself forcing something, chances are you need to re-evaluate your technique
I will keep this brief but as somebody who suffers from small bowel obstructions almost every other week due to an intestinal disease I have had many NG tubes and by far the worst two experience were whenever they couldn't go down my my esophagus due to me vomiting up bile so it ended up coming right through my mouth and cutting my upper gum the second incident was where they pushed it down my esophagus and made it into my stomach but they had punctured a small hole in my stomach due to the force they use to put it in. I will state this personally these things are hell to put in and hell to remove, also they tend to pull out your nose occasionally if you move your head too much which is torture having to push it in yourself.
Just a normal civilian here. I once came upon an overdose. He was not responsive and taking 1-2 breaths per minute, and had a “snoring” sound with each breath. Would this have been an ideal time for an NPA? I didn’t carry one at the time, but have since added it to my IFAK in the car. 911 just advised me to start CPR on him.
@@theparaminutemanRight! I don't believe you even do rescue breathing if they are still breathing on their own. Terrible advice from 911 call center. Been a while since I have had a cpr class, but ive had many of them. As for this NPA device in the vid, have no idea , so glad prepmedic responded to your question. But Narcan would prob have been the best thing for that guy OD'ing.
Call centers will have you start CPR if the patient is unresponsive with ineffective breathing. Ultimately CPR won’t do any long term harm to someone who still has a pulse but withholding CPR from someone who needs it will.
That's horrifying. I mean it may be necessary depending on the situation but that doesn't make it any more comfortable for a patient who has any level of consciousness.But hey; now we know about the NPA, its uses, how to do it, and the nuance of it all.
What if you come across an obstruction in the nasal passage about halfway down the tube? Would it be safe to continue insertion, or would it be best to stop? I've tried this on myself and it gets to a point where it hits something down my nasal passage. Please help.
Question from a first aid semi-noob trying to get a little more current - can that be self-applied the same way? Granted it would be case specific with time and stress being an issue, but I've seen some really interesting combat medicine being self-administered over the last 2 years.
Seems quite similar to the way you insert an NG tube.. How would you aim it at the trachea and not the oesophagus , or doesnt matter as long as it keeps the nasal part of the airway open?
The explanations (not just in your videos) of when someone with basic training should use an NPA always seems too brief. It would be good to have a video that goes a little more into it. Also, I was taught about three months ago to twist the NPA as it is going in. Is that wrong, does it matter?
Say you notice the patient is about to throw up would you have a specific side you would want to lean them? Like if the NPA was in the right nostril would you lean the patient left?
My medical training is somewhat limited. Working on my ALS/PALS. But I believe inserting an NPA without lubrication can cause tissue damage along the nasopharynx. If you don’t have lube, you can buy NPAs that come in a bag and are prelubed
From my reaseach lately, i believe that answer is NO. But don't take my word for it. Common sense on how this procedure works is you would def need lube. I have some pre lubricated ones, and in the package I can barely see any lube at all...if any. So idk but the pre lubricated ones I have are no where near the amount Prepmedic put on this NPA before he put it in...
So pretty much the only time you would use this is when the tongue is the obstruction? Any other instances? This particular piece of medical equipment has always confused me because "it's not like it would work on someone choking. So why would I want it in my pack?"
When someone goes unconscious, their muscles tend to relax and the tongue falls back into the throat covering the epiglottis and inhibiting breathing. We commonly put them in on overdoses, extreme ETOH (Alcohol) patients or anyone who can breath on their own, but still needs assistance maintaining their airway.
In our contry is Invasive entry and therefore not much for a civilian, especially if there will be someone who will be able to keep their head in line, as a rule, but it's good to be able to experience it. We also teach that we do not insert NPA if there is a suspicion of a serious head injury or if the patient does not want to accept it
My wife has had spinal fusion on her C-4 through C-7 and her Epiglottis does not work all the time. She wakes up choking at night some times and I am afraid that she will suffocate. Would this work that that case?
No. This airway is only sitting in the nasopharynx and does not extend past the epiglottis. Although that would be an interesting one to explain in couples therapy 😂
QUESTION: Hey sam, been watching your videos for a few years now every little while, I'm currently 17 and I am looking to purchase some medical supplies (tourniquet, gauze etc) my main issue is that I have Eczema on my hands and typically have anywhere from 2 or 3 fingers on my hand to 20 or more varying in size, will gloves be good enough and just call it a day?? Also another question, based on my age you can probably tell I have no medical experience but I want to take a few classes locally on things like CPR AED #stopthebleed and what not, any recommendations, tips, companies you would recommend? any classes you'd recommend in particular?
That did NOT look comfortable. Anyway, I am the field medic for my school. I mainly do Soccer, but next season I'll be doing football and other contact sports. There's always a chance of head and spinal Injuries. I mainly work with small to average sized females but I do work with average sized males aswell. I was wondering what size NPA tube I should get. Do I just get the standard 28 French or do I go smaller?
Shouts out to the live dummy taking one for the team.
**hats off** that was the calmest reaction of CONSCIOUS NPA insertion I've ever seen! Like a champ!
Right! And this is coming from someone who has performed the human blockhead with a timber spike. That's off.
Uff, guy deserves all the credit hes getting for taking it like a champ!
Thank you for the live demo... it helps a great deal to "get the concept" of administering care.
I agree!
Props to the patient for demonstration. As a former EMT I've done this on myself and it is not fun.
Same. I'd do it again but not for fun.
Dang ! He is a good patient !!
Thank you for demonstration and Brian for his patience!
For this video the hero is that dude.
keep it coming. these refreshers are super helpful
Glad to hear it!
Kudos Brian for being the demo manikin & not gagging 😂 😉😎👌
Congrats to Bryan. He had handled this like a champ
I love this channel. So much life saving content. Thank you 👍🏻👍🏻
Great video. It was super helpful seeing a live demonstration.
Awesome, a new bar trick! My buddies won't be expecting this one
Good stuff, as always. Just a thought for a future series, you could walk everyone through the TCCC MARCH algorithm by breaking down each skill you need for MARCH skill by skill.
That would make a great video
That poor guy on the table started to look a little panicky right before you pulled that garden hose out of his nose 😂. Thank you so much for this video and the actual demo!
20 years an a Flight Medic /Pilot, OUTSTANDING demo, with the poor quality EMT/Medic schools that are going on in todays world students could learn alot from this video!
Thanks for sharing this, and kudos to Brian for his wonderful participation.
In my area, they still teach not to insert an NPA when you observe or suspect a head injury. I agree that the NG tube is smaller and would be more likely to find its way through the ethmoid and into the brain vs the larger NPA. But we have to follow medical control and I'm sure you will agree that whatever they says goes and the M.D. behind their name stands for my decision lol.
Same. My EMS services medical director is really big on it.
Both are great opportunities to dig into the literature and present it to your medical directors to drive positive change.
Your medical director is stuck in 2004, there has never been a case where an NPA was inserted into the brain.
@@theparaminuteman I thought I read that there were only like 2 documented cases of NPAs. But that might have been the NG tubes. I'd have to look at that study again to be sure.
Have inserted a nose hose on myself and others more times than I can remember. Either in training or down range.
👍👍👍
For the horizontal human!
You’re brave….
Fantastic topic and review for some. As you know, another advantage of an NPA over an OPA is that if some form of advanced airway becomes available than one saves a bit of time (yes, minimal) having to remove the OPA. THE NPA could be left in place in a pinch. (1…2…3… argumentative comments begin. lol 😮)
Good video. Kudos to live demo. The lubricated bevel is inserted along the midline because the turbinates attach laterally and with gentle pressure can avoid the complication of epitaxis.
Awesome! Always look forward to your videos: great new info and excellent refreshers.
Wow, he took that like a champ!
Your patient is a trooper
Thanks. The live demo was fantastic.
Bro took it like a champ... Wow.
Damn, props to Brian
Thank you, Sam. That a very useful and understandable explanation.
Especially for me as a not native English speaker, an overlay with subtitles of the specific terms would be nice.
Great demonstration!
This was very helpful.
Brian, you're just amazing! 🤣
No questions here, just thank you 😊
Thank you for this. And a huge thank you to Brian too.
Hello, this channel is one of my favorites for information on this subject and thank you for making such awesome videos. I was curious though, I have sleep apnea and have to use a CPAP machine to sleep at night otherwise there's obstructions, I start snoring and I stop breathing. It's a real problem when we have power outages and I can't use the CPAP. Would this device work for keeping the airway open while I sleep? Assuming the gag reflex isn't a problem of course lol.
got it. Me and the boys will be trying this out at the next sleepover
Please do a video on ARS needle decompression
Awesome demo, more like this for CEU.
Helpful & Life saving ❤
Thank you!
As always, great, clear instructions!
That hurt my nose just watching it! Great demo!😂
Thanks for the great video! Does tilting the head back and pushing the jaw forward do the same thing as an NPA? Or is there something specifically better or different about NPAs? I know that one obvious advantage is that you don’t have to stay at their head maintaining the head tilt/ jaw thrust
Kudos to your patient!
Thank you for all your videos.. In an emergency situation if a medic was down to their last NPA, but it was found to be too large for the casualty, is it permitted to cut the tube to size as long as the diameter and curvature of the tube was not a compromising factor??
Great video! I learned something new today.
Can you make a video on when to/not to give someone comfort items like water, pain meds, etc. depending on scenario?
Excellent Demo ! Thank you!
Very insightful info .
So if required to insert on a conscious patient who's had trauma or below 95 on O2 that would be possible to ensure better airflow?
Or would you have a tripod them?
10/10 video!
love ur channel bro
awesome videos man, i got some questions. when packing, how do you prevent from pushing the bullet even deeper? and can you talk a bit about TQ removal? thx everyone who responds 😊
Has Brian been to SF scuba, Buds, or MCD? Looks like he’s familiar with shutting down his nasal breathing haha. Great videos. Ive done most of this stuff but these are great refreshers! Spit on it before you stick it in 😊
When measuring the NPA, you mentioned if you have extremes on either side you might want to go up or down. Could you explain that? Thank you!
Had one three weeks ago. I had blood and blood clots in my sinus for two weeks. Practice and practice more all it takes is one hard push and you have another issue to worry about.
Outside of orthopedic surgery, very few medical interventions require high force. If you find yourself forcing something, chances are you need to re-evaluate your technique
I will keep this brief but as somebody who suffers from small bowel obstructions almost every other week due to an intestinal disease I have had many NG tubes and by far the worst two experience were whenever they couldn't go down my my esophagus due to me vomiting up bile so it ended up coming right through my mouth and cutting my upper gum the second incident was where they pushed it down my esophagus and made it into my stomach but they had punctured a small hole in my stomach due to the force they use to put it in. I will state this personally these things are hell to put in and hell to remove, also they tend to pull out your nose occasionally if you move your head too much which is torture having to push it in yourself.
Just a normal civilian here. I once came upon an overdose. He was not responsive and taking 1-2 breaths per minute, and had a “snoring” sound with each breath. Would this have been an ideal time for an NPA? I didn’t carry one at the time, but have since added it to my IFAK in the car. 911 just advised me to start CPR on him.
Yeah, that would have been a pretty picture perfect time to use it. That being said, make sure you know the laws In your area.
@@PrepMedic That’s what I was thinking. Thanks! The medics said that if he pulled through, he would feel the sternum rubs for a while 😂
Please do not start cpr on people that still have a pulse.
@@theparaminutemanRight! I don't believe you even do rescue breathing if they are still breathing on their own. Terrible advice from 911 call center. Been a while since I have had a cpr class, but ive had many of them. As for this NPA device in the vid, have no idea , so glad prepmedic responded to your question. But Narcan would prob have been the best thing for that guy OD'ing.
Call centers will have you start CPR if the patient is unresponsive with ineffective breathing. Ultimately CPR won’t do any long term harm to someone who still has a pulse but withholding CPR from someone who needs it will.
Dude, it's been a while, did you get hurt under the left eye? I am now a nursing student, thanks a lot for your tech support.
Great job!
Have you heard about the new thoughts on sizing that deal with patient height and not nose to ear?
That's horrifying. I mean it may be necessary depending on the situation but that doesn't make it any more comfortable for a patient who has any level of consciousness.But hey; now we know about the NPA, its uses, how to do it, and the nuance of it all.
And believe it or not it’s one of the less horrifying things we do in EM
@@PrepMedic Christ almighty... It gets worse...?
Shoutout to all the other people watching that learned how to insert an NPA on themselves merely out of boredom 😂
What if you come across an obstruction in the nasal passage about halfway down the tube? Would it be safe to continue insertion, or would it be best to stop? I've tried this on myself and it gets to a point where it hits something down my nasal passage. Please help.
Brian...bruh 👏🏼
Question from a first aid semi-noob trying to get a little more current - can that be self-applied the same way? Granted it would be case specific with time and stress being an issue, but I've seen some really interesting combat medicine being self-administered over the last 2 years.
Thanks for all the info 😅
Seems quite similar to the way you insert an NG tube.. How would you aim it at the trachea and not the oesophagus , or doesnt matter as long as it keeps the nasal part of the airway open?
The explanations (not just in your videos) of when someone with basic training should use an NPA always seems too brief. It would be good to have a video that goes a little more into it. Also, I was taught about three months ago to twist the NPA as it is going in. Is that wrong, does it matter?
Nice, now do an OPA on him!
I almost gagged when you pulled it out of his nose!!:p
Haha we had a trashcan standing by for Brian if he barfed
Say you notice the patient is about to throw up would you have a specific side you would want to lean them? Like if the NPA was in the right nostril would you lean the patient left?
Whichever side I am not standing on.
@@PrepMedic 10-4 thank you.
Would this be used on someone with anaphylaxis if their throat is closing up and no epi-pen available?
Probably not. The throat is below the nose. If the throat is closing up putting something in the nose wont help
What if someone anxiety are they sedated?
Can an NPA be inserted w/o any lubricant at all?? It’s been awhile since I went thru my IFAK but I don’t recall any lube with or for the NPA. Thanx.
My medical training is somewhat limited. Working on my ALS/PALS. But I believe inserting an NPA without lubrication can cause tissue damage along the nasopharynx.
If you don’t have lube, you can buy NPAs that come in a bag and are prelubed
From my reaseach lately, i believe that answer is NO. But don't take my word for it. Common sense on how this procedure works is you would def need lube. I have some pre lubricated ones, and in the package I can barely see any lube at all...if any. So idk but the pre lubricated ones I have are no where near the amount Prepmedic put on this NPA before he put it in...
So pretty much the only time you would use this is when the tongue is the obstruction? Any other instances?
This particular piece of medical equipment has always confused me because "it's not like it would work on someone choking. So why would I want it in my pack?"
When someone goes unconscious, their muscles tend to relax and the tongue falls back into the throat covering the epiglottis and inhibiting breathing. We commonly put them in on overdoses, extreme ETOH (Alcohol) patients or anyone who can breath on their own, but still needs assistance maintaining their airway.
@@NoDadNotTheBeltt that makes sense, thank you for the clarification.
In our contry is Invasive entry and therefore not much for a civilian, especially if there will be someone who will be able to keep their head in line, as a rule, but it's good to be able to experience it. We also teach that we do not insert NPA if there is a suspicion of a serious head injury or if the patient does not want to accept it
Most excellent. How much did you pay your live model? I bet his eyes were watering!
A chipotle burrito and a hug 😂
What about deviated septums
My wife has had spinal fusion on her C-4 through C-7 and her Epiglottis does not work all the time. She wakes up choking at night some times and I am afraid that she will suffocate. Would this work that that case?
No. This airway is only sitting in the nasopharynx and does not extend past the epiglottis. Although that would be an interesting one to explain in couples therapy 😂
@@PrepMedic 🤣🤣🤣 Thank you!!
QUESTION: Hey sam, been watching your videos for a few years now every little while, I'm currently 17 and I am looking to purchase some medical supplies (tourniquet, gauze etc) my main issue is that I have Eczema on my hands and typically have anywhere from 2 or 3 fingers on my hand to 20 or more varying in size, will gloves be good enough and just call it a day?? Also another question, based on my age you can probably tell I have no medical experience but I want to take a few classes locally on things like CPR AED #stopthebleed and what not, any recommendations, tips, companies you would recommend? any classes you'd recommend in particular?
A great place to start is just calling your local fire department. Many departments give free or low cost CPR and first aid classes.
Stud!
The only unrealistic thing is that I can’t imagine you actually doing it to someone who is that aware and alert. I sure as blank would not allow it.
What would you recommend for pediatric airways? Trying to build out a kit for the kiddo in case anything happens
It depends what the “anything” you are preparing for is.
Brian must’ve owed you
That did NOT look comfortable. Anyway, I am the field medic for my school. I mainly do Soccer, but next season I'll be doing football and other contact sports. There's always a chance of head and spinal Injuries. I mainly work with small to average sized females but I do work with average sized males aswell. I was wondering what size NPA tube I should get. Do I just get the standard 28 French or do I go smaller?
How long have you been Colorado now with your family?
Wait, this is inserted in the nose?
Is there a playlist of how to?
Idk what made me click this video while eating lunch. But here we are 🤷🏽♂️😂
And?? Is that like a big deal?? There is nothing graphic about this if youre not a poofter
Casey Light
Great video and instructions! Should of shown opposite nostril as well.
💪🏻💯
Jasper Ways
Sam: "Hey friend, hear me out... I just need you to lay down...No no, trust me."
1st🎉
NPAs: tipping the gaff to the human blockhead trick since before covid swabs.
i thought sizing was based on height?
LMAs, Kings, and IGels are height based but not OPAs or NPAs
You say not a single one has been inserted into the brain incorrectly. My question is, how do you insert one into the brain correctly?
3:08 wait.....that means there is a correct way to insert one into the brain. EXPLAIN!!
There is a blooper where I stop directly after that statement and say “well there isn’t a correct way to insert it into the brain soooo”
Can we get Con Ed hours for this? Lol How much did you hsve pay Brian beer to do the live demo? Lol
I paid him one chipotle burrito 😂