Nasal pharyngeal airways

[rondog]

Last time I took a Red Cross CPR Course there was heavy emphasis on getting permission from the injured party first before even touching them. If possible, of course. Very heavy emphasis on protecting YOURSELF from liability.

[Irving]

NPAs and OPAs (and other airway devices) are a tool for trained people. If I'm off duty I'm going to think real hard about giving one to somebody who I don't know and won't die without one. Too many people run around with tools they aren't trained to use.

I think that the instructions for NPAs are so simple, and they are so cheap, that people pick them up. However, it seems like in order for one to be necessary, the rest of the situation would be far from "simple."

[Tim K]

If you're afraid to use it, just safety pin the tongue to the lower lip.

[anaphylaxis]

Last time I took a Red Cross CPR Course there was heavy emphasis on getting permission from the injured party first before even touching them. If possible, of course. Very heavy emphasis on protecting YOURSELF from liability.

True, but if one gets to the point of inserting an airway adjunct, chances are good that the victim will have a decreased level of consciousness or be unresponsive. It should be easy to articulate implied consent at that point.

As to the whole issue of inserting an OPA/NPA if not on duty, they are basic airway devices. Like anything else, a person should have some level of training in their use. To get sued successfully, one would have to cause some level of harm. Basic level CPR and first aid training only teaches the recovery position and head tilt, chin lift to open an airway. Granted, airway trumps c-spine considerations but it would be reasonable to establish a patent airway using an NPA/OPA to avoid possible c-spine compromise caused by manual airway maneuvers.

FWIW, there have been studies done to measure the ability of a lay rescuer to establish a patent airway using supraglottic airway devices. They've shown a very high success rate following minimal training. http://www.ncbi.nlm.nih.gov/pubmed/23887642

[nynco]

Just a word of warning, NPTs have risk with them. If not done properly and on the right person, they can induce vomiting. Which if the victim is on their back and they vomit, you got some big problems.

[cmailliard]

True, but if one gets to the point of inserting an airway adjunct, chances are good that the victim will have a decreased level of consciousness or be unresponsive. It should be easy to articulate implied consent at that point.

As to the whole issue of inserting an OPA/NPA if not on duty, they are basic airway devices. Like anything else, a person should have some level of training in their use. To get sued successfully, one would have to cause some level of harm. Basic level CPR and first aid training only teaches the recovery position and head tilt, chin lift to open an airway. Granted, airway trumps c-spine considerations but it would be reasonable to establish a patent airway using an NPA/OPA to avoid possible c-spine compromise caused by manual airway maneuvers.

FWIW, there have been studies done to measure the ability of a lay rescuer to establish a patent airway using supraglottic airway devices. They've shown a very high success rate following minimal training. http://www.ncbi.nlm.nih.gov/pubmed/23887642

^^All good here^^ King's for the win

Insertion is very easy to do with some basic practice (we use an airway head in my classes). I just inserted 4 of them on students in my high school class a few weeks ago. All four went down easily with only one needing to switch to the other nostril. TacMedSolutions has a great video of insertion on a live person.

As far as liability I have yet to find anything specific about NPA use. It is a basic skill and is included in BLS IFAK's (as opposed to an ALS kit that includes a chest decompression needle). Personally I think it is a great tool that is very non invasive, easy to learn, easy to use, low risk of complications, and cheap. No reason not to learn how to use one and have one.

[Rabid]

When you get an EMT cert you are going to spend more time on liability risk and prevention then anything else, i would say it was a 1/3 or more of my training. Even though a low A/O gives you implied consent it does not mean you can do anything you want. If someone needs a NPA they are already in harms way and doing one puts liability on you and doing one without documented training just increases your liability. When hospital bills go up people will sue anyone to help pay for the costs. Even if you are sued unsuccessfully, that is still tens of thousands out of your pocket on lawyer and court fees.

If you are ever in a situation please keep one thing in the back of your mind; The path to hell is paved with good intentions.

[Jeffrey Lebowski]

I will agree. Do I have them? sure. Do I carry them in the kit that goes to the range? No. Have I been trained? yes. Have I ever used one on a real person? no.

I'd be curious how many folks here have done this.
I was an EMT for all of college, and although this was a long time ago, I never once used one even on 911/fire calls. Never intubated. Never used the defib.
These are some exotic toys we're talking about for a first aid kit. Difficult for me to get excited about this kind of thing when I didn't get to use them even when I wanted to do so.

At this point, I don't even have a CPR card anymore, though.

[helopitts]

In my line of work, I get to watch all of those cool tools get used on a regular basis (intubation, needle decompressions, chest tubes, Edison medicine, etc...) where I totally agree that all of those tools need to be used by a qualified person. If there is a range accident and a friend of mine wants to shove a rubber hose up my nose so that I can breath, by all means go ahead. On the other hand if someone wants to needle my chest because they learned how to do it on youtube, Ill wait for a helicopter.

[cmailliard]

On the other hand if someone wants to needle my chest because they learned how to do it on youtube, Ill wait for a helicopter.

I'll take a Chest Seal to buy some time, but yeah, no needle.