When to use a NPA or OPA!
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- Опубликовано: 18 апр 2019
- One of the questions I get asked a lot is when should you use an airway adjunct such as a OPA or NPA. When your patient can not cough or swallow then you need to protect their airway. If they can't cough or swallow this means they can't protect their own airway against blood or vomit.
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Yes, airway protection is the first in ABCs. NPA is the best option unless the patient has no eye, verbal, or motor response to stimuli. If that is the case, an OPA is just buying time until intubation can be achieved. If you place an OPA in a patient that otherwise "can not cough or swallow" or is “semiconscious” but is maintaining an airway, you're likely to elicit a gag response. No bueno in a patient that is already having difficulty protecting his or her airway. This is key. Just because a patient can not cough or swallow on command does not mean the patient’s airway is compromised. Look at respiratory rate and oxygen saturations and other vitals. Intoxicated people do not follow commands to cough or swallow, but protect their airways. As per medical literature, “Oropharyngeal airways (OPAs) should only be used in a deeply unresponsive patient who is unable to maintain his or her airway. In responsive patients, they can cause vomiting and aspiration.” It is mentioned that, “Using the device in a patient with intact airway reflexes can inducing vomiting. The OPA must be removed if protective reflexes are present.” Additionally, “Patients tolerate NPAs more easily than OPAs, so NPAs can be used when using an OPA is difficult, such as when the patient's jaw is clenched or the patient is semiconscious and cannot tolerate an OPA.” Unless you’re about to tube a patient or lack the resources to do so, an NPA will likely suffice. If you use an OPA and the patient tolerates it, he/she needs an endotracheal tube.
Thank you, man. This comment was so helpful
TCCC
Wow what a informative comment!
Thank you! Are you a paramedic?
@@becky2235 I'm an ER PA!
Can you put an unresponsive person with an NPA into a recovery position?
Instructions unclear, loud snoring girlfriend is now loud yelling girlfriend.
Your doing great work brother!!!
Haha.... the bloopers. Love it!
I’m no where near qualified to perform this procedure. I’m more like the medic that used his bare hands to stop the bleeding of man in after action report on the guy that was stabbed multiple times. I’m minimally qualified for wilderness and remote first aid. If I’m the first responder , that’s all I can do. That’s why I watch these videos. God Bless and have a Happy Easter !
lol u need a lil more confidence in yourself
You can do it Mr. Wilderness Responder man.
Thanks, man.
Bloopers at the end. :)
Disqualifier for an opa is gag reflex disqualifier for npa is head trauma/ skull fracture.
thats not a word
Haha. Good stuff!
Ok, but the question nobody seems to answer is: when to prefer an NPA over an OPA.
Usually we place the NPA when an OPA isn't possible, but why? Is the OPA better?
OPA keeps the tongue away from the throat less gag reflex when unconscious, Ive never used a NPA "YET" but what i seen on scene is the BVM with the OPA inserted does it's job...
a first aider ( which is not a paramedic or doctor ... ) do they have a permission to use the NPA and the OPA ? or do they need a certificate ?
You went way too fast in this video. This topic should be explained much clearer.
They dont call him skinny for nothing.
What’s the simple answer
I'm not sure if you still reply to these comments but I'll ask anyway-
If I know someone is having an anaphylactic reaction (immideate, snapping closed of the airway after a very obvious cause such as bee sting or allergen-carrying food or plants) is it correct to use an NPA?
The patient wouldn't be able to cough or swallow, I'm sure, but I'm curious if this is a valid use for one if I wasn't able to treat with something more desirable (Epi-pen)
not sure if you've gotten your answer but I'll take a stab at it if not!
If they're having an anaphylactic reaction, its their throat that's closing. You'll wanna maintain the ability for the throat to allow the movement of air, but an OPA aint gonna cut it since that's really just to keep the tongue from occluding the airway. Similarly an NPA will be equally useless. You'll want an I-Gel or a King tube to stick down their throat to prevent it from totally closing. Of course, you're gonna wanna try giving epi 1:1,000 or diphenhydramine first, and if they're conscious they're not gonna be happy about the igel/king lol
Which do you use? Opa first nap last
OPA if they have not gage reflex and NPA when they do.
I was hoping to see an explaination of scenarios to use one instead of the other. IE not using NPA if brain fluid ls leaking out.
Can someone more knowledgeable than me give me some advice please?
I'd really appreciate it!
Once you have the N.P.A. in if the patient was to stop breathing, would you give normal rescue breaths? Sorry I'm new to N.P.A.'s and O.P.A.'s, I understand the role of a O.P.A. in securing a airway, i.e. stopping the tongue from blocking the patients airway,but I don't understand how a N.P.A. could do the same job? Yes they can breath through there nose with it but say for instance the tongue was blocking the airway how does a N.P.A. help then?
ANY advice to this beginner would be really appreciated
you can google these ways or here on youtube will assist in many way plus techniques on whats needed with sinerial .lots of instructors on youtube to watch and learn
First in abc and second in pmarchp
Nice
Hopefully it helps!
kind of ended abruptly there..
Let's say they're unconscious and are not coughing or swallowing, obviously you cant ask them...what then, apply NPA to be safe?
If you have to ask that question you shouldn't be anywhere near an airway adjunct and it's outside your scope to use one. But to answer the question: An OPA is contraindicated in a pt with an intact gag reflex. If they have a gag reflex, go for the NPA unless there's facial trauma or basilar skull fracture.
I'm a fan of your channel. You provide a lot of good and important information to the public. This time what you're saying is not correct.
Neither OPA nor NPA protect your airway in any way. They ARE an airway. These are both methods for getting past an unfriendly oropharynx to the posterior oropharynx to open a path to oxygenate a patient. You use an NPA on a conscious patient, and an OPA or NPA on an unconscious one, because OPA is uncomfortable and induces gag. To protect an airway you need a device that isolates the trachea from the esophagus and the mouth, so either an LMA and it's various cousins (if the only thing available) or an endotracheal tube/tracheostomy with an inflatable cuff. I'm happy to explain this in more detail if you wish.
They protect the airway by keeping
the tongue from blocking the airway. You are correct too but I am not wrong.
@fhgnius Why would think an LMA is an appropriate airway for "protecting" and airway? It doesn't isolate the esophagus from the trachea and it is the worst SGA I've ever used. My opinion is that it has no place outside of an OR where the patient has been NPO for at least 12 hours. While an NPA doesn't "protect" the airway, it does move tissue and let's face it, moving tissue is usually what we need to do. Pulling the tongue forward is the first step in effectively opening an airway. The NPA obviously doesn't do this as it was designed to provide a clear path for oxygen and a suction catheter. Yes, the "Gold Standard" is an ETT but I believe this video is providing a basic decision making algorithm for non-pressional / non-credentialed rescuers.
Wow your arrogant
1st
Awesome!