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  1. #1
    Super Moderator Patriotic Sheepdog's Avatar
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    Nasopharyngeal and Oropharyngeal Airways

    Nasopharyngeal vs. Oropharyngeal Airways

    I briefly stated in the BOK content thread that I carry Oropharyngel airways (OPA) and others stated that they carry Nasopharyngeal airways (NPA). So who is right? Well, both serve a purpose. In this thread we can discuss the pros and cons of both.

    To start, both are tools to open or protect an airway. They are tools that you should always have near you as you will never know when you will need to use one. Their design is completely different and their insertion techniques are different as well. You should be trained in the insertion of both as you never know when you may be called upon to render aid to multiple patients.

    As with any medical device it is imperative that you know when and when not to use them as well as being competent on how to use them. Using these at the wrong time or having improper insertion technique can cause harm and possibly death to your patient.

    Letís compare the indications and contraindications of both.

    OPA indications;
    1. Patient not breathing.
    2. Patient unconscious without a gag reflex.

    Contraindications for an OPA would be;
    1. Patient is conscious.
    2. Patient has a gag reflex.
    3. There is some foreign body that is blocking the airway, such as food, dentures, etc that should be removed first.

    Indications for a NPA are;
    1. Any patient that is not a candidate for an OPA.
    2. Patient is semi-conscious with a gag reflex or unconscious.

    Contraindications for a NPA;
    1. Patient with significant head trauma.
    2. Patient with nasal fractures.
    This is significant because inserting a NPA in a patient with either of these problems could result with the NPA being inserted into the brain. This has been confirmed, but it rarely happens, but it is still a relative contraindication that you should be aware of.

    Personally, I feel if your patient is unconscious without a gag reflex an OPA should be used initially. My reasoning is that it will provide the additional benefit of holding the tongue which will provide a better airway. Someone trained can usually insert an OPA quicker than someone else can even get the NPA lubricated.






    Insertion techniques:
    OPA:
    1. Measure from earlobe or angle of the jaw to the corner of the mouth for correct OPA size.
    2. Open the patientís mouth and insert the OPA with the tip facing the roof of the mouth. Insert the OPA until it touches the roof of the mouth and then slowly rotate the OPA 180 degrees while continuing insertion. The flange of the OPA should rest on the lips.

    NPA:
    1. Measure from the tip of the patients nose to the earlobe to select the proper length. To choose the proper diameter choose a NPA about the size of the patientís nasal opening or some say about the size of their little finger.
    2. Lubricate the NPA with a water soluble jelly/lubricant.
    3. Place the NPA in the larger nostril with the bevel of the NPA towards the nasal septum. Be sure the NPA follows the curve of the floor of the nose. When the right nostril is being used make sure the bevel faces the septum and insert until the flange rests against the nose. When using the left nostril you may need to have the bevel pointing upwards and turn 180 degrees when inserting. Again, the flange should rest on the nostril when fully inserted.

    Here are some YouTube videos that show the insertion techniques.

    Insertion of an OPA. http://www.youtube.com/watch?v=SvoJfxRbpkg&NR=1

    Insertion on a NPA. http://www.youtube.com/watch?v=En2sX...eature=related

    A quick look online and I found a NPA kit here http://www.egeneralmedical.com/mme-52971.html, and OPA set here http://www.themedicalsupplydepot.com...c2670_a_7c5974. I have no affiliation with either company and cannot vouch for their service so buyer beware and do your research.

    So bottom lineÖboth are valuable pieces of equipment and it could benefit you to carry and know how to use both the OPA and NPA. Get practice and become efficient with both.

    Hope this helps.

    PSD
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  2. #2
    Administrator protus's Avatar
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    great post PSD, thanks !!!
    To add to the whole "theme" of things. while i carry both in my BOK/range bag kit. Which would you carry in your IFAk or like me do you just shove both in there? Is there a it works better in this type of enviroment vs others aka medical vs battlefield setting? again great thread!
    Uhhh....I'll do it.......

  3. #3
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    Quote Originally Posted by protus View Post
    great post PSD, thanks !!!
    To add to the whole "theme" of things. while i carry both in my BOK/range bag kit. Which would you carry in your IFAk or like me do you just shove both in there? Is there a it works better in this type of enviroment vs others aka medical vs battlefield setting? again great thread!
    Carry both. As Patriotic Sheepdog explained the airways are for different types of paients and different types of levels of consciousness. Oral airways usually wont work on patient with some responsiveness due to the fact that they most likely will have an intact gag reflex. Nasal airways cant be used on suspected head injuries or patients with facial trauma.
    These airways aren't heavy and don't take up much room.
    Just to add a little to P.S.'s post, NEVER use a petroleum based lubricant on nasal airways. The petroleum will start to break down the latex in the airway almost immediately. Also if you are using oxygen in conjunction with the airway there is an obvious fire hazard there. Make sure you use only water soluble lubricant.

  4. #4
    Sharpshooter and I got ours in so Grand can volunteer to let us practice now!!
    Got a question. I see how they measure them and was shown once in person by our medic but i didn't ask him, how much leeway do you have? I mean can it be an inch to long or 1/2 inch too short and still be functional?
    Knowledge is Power, Practiced Knowledge is Strength, Tested Knowledge is Confidence

  5. #5
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    Quote Originally Posted by Matt In Oklahoma View Post
    Sharpshooter and I got ours in so Grand can volunteer to let us practice now!!
    Got a question. I see how they measure them and was shown once in person by our medic but i didn't ask him, how much leeway do you have? I mean can it be an inch to long or 1/2 inch too short and still be functional?
    With the Nasopharyngeal a little too long is not a huge issue. With the orals though, you have to be precise. If you use the wrong size the tongue can and will move and obstruct the airway.
    Don't stress over it though, these airways are very easy to use. A little practice and you will be an expert.

    One thing not mentioned. If you are using an oral airway on an infant. DO NOT do the 180 degree method. You run a high risk of damaging the soft palate, Just insert following the contour of the airway.

  6. #6
    Quote Originally Posted by Fido View Post
    With the Nasopharyngeal a little too long is not a huge issue. With the orals though, you have to be precise. If you use the wrong size the tongue can and will move and obstruct the airway.
    Don't stress over it though, these airways are very easy to use. A little practice and you will be an expert.

    One thing not mentioned. If you are using an oral airway on an infant. DO NOT do the 180 degree method. You run a high risk of damaging the soft palate, Just insert following the contour of the airway.
    Thanks, I appreciate it
    Knowledge is Power, Practiced Knowledge is Strength, Tested Knowledge is Confidence

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