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Enso
11-01-2009, 21:47
Gentlemen,

Im looking for opinions on the use of the nasopharyngeal airway. In my fledgling military career, I have come across competing direction as to whether the NPA is really necessary in a combat environment.

Obviously the NPA is to be used for patients that are conscious, as he would be receiving an oropharyngeal airway if he were not (provided he did not suffer mandibular trauma or something of the like).

Traditional Big Army teaches the above, however I have run across a few dissenters. These individuals state that the NPA is unnecessary for patients that are conscious because they would obviously have a patent airway. The argument then usually evolves into the effectiveness of the OPA vs the NPA (OPA wins), and then the point that if aforementioned patient slips out of consciousness he would then receive the OPA.

Closing point: Inserting an NPA on a patient with a patent airway is an unnecessary waste of crucial seconds in a tactical environment.


As a young medic, Im caught between following big Army doctrine and experience-based knowledge from my superiors. Id like to see if this is a valid argument based on a variety of opinions from those much more experienced and schooled then I.

Thoughts?
:munchin

Dozer523
11-01-2009, 22:14
Second post? You are a medic and and EMT ( I took the time to check your profile). I also searched "NPA" and got 21 thread returns. Betcha your question was addressed. Come on man, let us like you.:D

Enso
11-01-2009, 22:23
Second post? You are a medic and and EMT ( I took the time to check your profile). I also searched "NPA" and got 21 thread returns. Betcha your question was addressed. Come on man, let us like you.:D

Dozer,

I decided against the "I searched this" disclaimer mostly because I felt like there is a higher percentage of QP corrective action for those that include it ;)


Searches resulted in various threads mentioning the inclusion of the NPA in aid bags and medkits, but I didn't come across anything that specifically addressed the necessity of an NPA on a conscious patient.

swatsurgeon
11-01-2009, 23:03
Google also is a friend...OPA's are designed to be placed in the unconscious patient. They were used first as an adjunct to an anesthesiologist when the patient is "completely relaxed or chemically paralyzed". It is a 'noxious' stimuli in the awake and altered patient who will either gag, vomit, chew or obstruct their airway when the OPA pushes their tongue posterior and inferior since they have maintenence of muscle (oral) tone...the NPA has no such evel side effects and can be placed in any type of patient, even those with massive facial injuries. I have yet to meet a patient (conscious or not), that I could not BVM with just an NPA for adequate ventilation......my backround is not anesthesia but is Trauma surgery and surgical critical care...I see the worst of the worst and I haven't used an OPA since 1995, just NPA's.

ss

Enso
11-02-2009, 22:20
Google also is a friend...OPA's are designed to be placed in the unconscious patient. They were used first as an adjunct to an anesthesiologist when the patient is "completely relaxed or chemically paralyzed". It is a 'noxious' stimuli in the awake and altered patient who will either gag, vomit, chew or obstruct their airway when the OPA pushes their tongue posterior and inferior since they have maintenence of muscle (oral) tone...the NPA has no such evel side effects and can be placed in any type of patient, even those with massive facial injuries. I have yet to meet a patient (conscious or not), that I could not BVM with just an NPA for adequate ventilation......my backround is not anesthesia but is Trauma surgery and surgical critical care...I see the worst of the worst and I haven't used an OPA since 1995, just NPA's.

ss


Roger, ss. Thank you for your input. This is a new perspective for me in that the NPA is used exclusively.

docstumpy
11-29-2009, 15:51
Personally, I carry at least two in my bag. The way I see it, is if your airway is THAT jacked up, and I can see some type of air bubbles rising, Im going to stick a sucker right there and pray to God Im getting some good out of it. I see NPA's as a time-buyer for crics or King LT's.

Enso
11-29-2009, 15:57
Personally, I carry at least two in my bag. The way I see it, is if your airway is THAT jacked up, and I can see some type of air bubbles rising, Im going to stick a sucker right there and pray to God Im getting some good out of it. I see NPA's as a time-buyer for crics or King LT's.

Thanks for the input, stumpy.

I've heard different things. The way I see it, they're good to keep in the toolbox, simply because they don't take up alot of room.

Surgicalcric
11-29-2009, 16:54
I have been a paramedic since 1991 -now an 18D- and havent used an OPA since about '94.

...The way I see it, they're good to keep in the toolbox, simply because they don't take up alot of room.

You may need to adjust your view.

NPA's are good to keep in the box because they work... ;)

Crip

Red Flag 1
11-29-2009, 18:01
FWIW,

NPA's are a great airway adjunct, even if they took up more room. Properly inserted, they do displace soft tissue and serve as a soft stint facilitating an airway. I have used them in the field as well as in the OR, PACU, ER, and ICU settings. NPA's are the only adjunct safe to use in a patient with intact protective reflexes.

I have used NPA's with patients enroute from the OR to the PACU. They are well tolerated by folks even as they wake up after surgery.

Do not sell these airway adjuncts short. During my years of clinical anesthesia practice and teaching, I have come to appreciate the simple things that work well. NPA's are minimally invasive, with few contraindications, and work very well indeed. Learn how to use them, and keep them handy if you are responsible for a patient's airway.

If you have these in your tool box because you have "heard things", you have a lot of reading to do. It also suggests you need more clinical exposure to airway management. I wonder what else is in your tool box because you have heard things?

My $.02.

RF 1

Enso
11-29-2009, 18:14
I have been a paramedic since 1991 -now an 18D- and havent used an OPA since about '94.



You may need to adjust your view.

NPA's are good to keep in the box because they work... ;)

Crip



Thank you Crip. I don't really have an opinion one way or the other in the OPA vs NPA debate.. As a conventional troop, before posting I was content to believe that the Army issued me both for a reason, but now after reading opinions of those much more experienced, things are leaning towards the NPA.

Which leads to my next question: Since you all favor the NPA, why do you think (other then inexperience/incompetence/whatever) this instructor would have this view? At the time, I believed him to be very knowledgeable.. Any thoughts on why he would feel this way?

Surgicalcric
11-29-2009, 19:54
... Any thoughts on why he would feel this way?

Any thoughts would be lil more than speculation.