OPA and NPA use

[Ace844]

Here's an example of why you shouldn't use a large bore suction cath through an NPA

(Airway Obstruction Caused by Nasal Airway

[Letters to the Editor)

Yokoyama, Takeshi DDS, PhD; Yamashita, Koichi MD, PhD; Manabe, Masanobu MD, PhD

Department of Anesthesiology and Critical Care Medicine, Kochi Medical School, Nankoku, Japan, yokoyamt@med.kochi-u.ac.jp]

To the Editor:

We report a case of sudden airway obstruction caused by a nasal airway that slipped into the trachea and the right main bronchus (Fig. 1). An 87-yr-old man presented with disturbance of consciousness (Glasgow Coma Scale score 9) after removal of a hematoma in the brain ventricle under local anesthesia. We inserted a nasal airway with an internal diameter of 6.0 mm to relieve the obstruction. Three days after surgery, we attempted pharyngeal suction through the nasal airway. The tube slipped through his nasal cavity into his trachea.

Figure 1. A, A nasal airway (inner diameter, 6.0 mm). B, The distal half of the nasal airway tube occupied the right bronchus, and the proximal half was located in the trachea.

A chest radiograph showed the tip of the nasal airway tube in the right main bronchus (Fig. 1). We placed the patient under general anesthesia with halothane in oxygen and removed the nasal airway without difficulty using Jackson’s laryngeal scope and forceps.

Takeshi Yokoyama, DDS, PhD

Koichi Yamashita, MD, PhD

Masanobu Manabe, MD, PhD

Department of Anesthesiology and Critical Care Medicine

Kochi Medical School

Nankoku, Japan

yokoyamt@med.kochi-u.ac.jp

[AZCEP]

THAT is impressive Ace.

Managed a TCA OD last week with NPA's X2, no OPA due to a gag. Couldn't intubate for a number of reasons, BLS airway management with no difficulty. Got to the ER, Doc used a fiber-optic scope to get the ETT in.

Patient released home after some discussion with a noodle doc.

BLS maneuvers do work. They take less time in class because everyone wants to learn the invasive techniques.

[Mastabattas]

For basics remember the basics... yes, it cannot be over emphasized, MJT, chin lift on non-trauma.

R/r... with regards to MJT...it has been mentioned in my EMR class but no time set aside for 'hands on' demonstration (of course not REAL demonstration)...but it was just lectured on as usual and that was it. Definitely not something I would feel comfortable actually practicing out in the field.

With regards to NPAs...we are being told not to use in cases of facial/head trauma for the classic reason of possible breach. We did however get told that it makes a handy dandy eye wash device.

My school seems to push OPAs above all else for both airway and bite.

Unfortunately, cross finger, or scissor finger technique on how to open a patients mouth safely and properly is not being taught much these days. SO man medics come in informing they "were unable to open the mouth" a little cross finger, opens it up.. no problem. I have yet been bit, when performing this properly (hint : properly).

I have no idea to what you are referring...but it sounds good. Perhaps I'll try a search on that.

[AZCEP]

Find yourself an airway manequin and practice the modified jaw thrust. It, like most patient care techniques, takes a little practice to get good at it. You will quickly realize that it is much more difficult to perform than the head tilt-chin lift.

I'm not sure I've ever heard of using an NPA for flushing the eyes. The nasal cannula is right handy for this purpose, but the NPA would seem to put too much volume into the face. OPA's are great for a BLS airway, providing the patient has no gag. If they do they tend to want to show you what they had for lunch. Instantly making airway management questionable at best.

[TerrfyinFlyinSrvc]

We report a case of sudden airway obstruction caused by a nasal airway that slipped into the trachea and the right main bronchus (Fig. 1). An 87-yr-old man presented with disturbance of consciousness (Glasgow Coma Scale score 9) after removal of a hematoma in the brain ventricle under local anesthesia. We inserted a nasal airway with an internal diameter of 6.0 mm to relieve the obstruction. Three days after surgery, we attempted pharyngeal suction through the nasal airway. The tube slipped through his nasal cavity into his trachea.

They make it sound as easy to do accidentally as dropping a soda straw down an open manhole.

Like, "Whoops!! It just dropped right down through., Oh well :dontknow: , it could happen to anybody."

I mean, didn't they notice it was slipping?

Once the end of the tube disappeared into the nostril, did they decide to go for the record or what?

Who was suctioning? Roto-Rooter?

After all, they were in a well-lit, non-moving/bouncing hospital room.

Couldn't they have retrieved it orally before it practically "fell" into his lung?

With the GCS and the hematoma, would anybody here have used a nasal airway?

Wouldn't they have bar-b-q'd an EMT or Paramedic who did this? I'd fully expect to have my butt mounted next to my head in some doc's office if I did this, and rightly so.

If I'm all wet here, please tell me so.

neal

[AZCEP]

What size does a 6.0 mm convert to in French?

Isn't a 36 Fr the biggest NPA available for most places? This patient's family now has their name on a sign in front of the hospital I'd wager.

Still, that is one impressive Cx Xray. :shock:

[TerrfyinFlyinSrvc]

What size does a 6.0 mm convert to in French?

Isn't a 36 Fr the biggest NPA available for most places?

20fr= 4.5mm, 22ff=5.0mm, on up to 36fr=8.5mm

Every =2fr = .5mm

So they were using a 26fr.

36fr is biggest avail according to the Allmed catalog, don't know about anywhere else.

[uglymedic]

vs-eh? could you please elaborate on the hesitation on ETI for a GHB OD? Thanks.

Also, concerning other items, has anyone ever flushed their own eyes with 0.9% Saline? Try it sometime! The equivalent is to pour a pint of El Toro tequilla in your eye. If you don't have it already, get some solution meant to flush the eyes.

ugly

[Asysin2leads]

Yoiu know, I'm gonna hijack the the thread here for a second, but this a good a place as any to share my tale of woe...

On Friday, a complex chain of events worthy of 'Final Destination' caused my partner to puncture an aerosol can of disinfectant when he went to adjust his seat, causing a high pressure stream of disinfectant spray to erupt into my face and eyes when I looked over to see what was hissing. Yes, temporary blindness, inability to open my eyes, all of that followed, and then, FOUR HOURS and several bags of normal saline later, I can safely say YES, I KNOW WHAT 0.9% SALINE FEELS LIKE IN YOUR EYES. IT was only halfway through that they blessed me with a few drops of tetracaine. Lucky for me it happened in the ER parking lot, and lucky for me there was nothing in the disinfectant that poison control thought was particularly dangerous. Don't leave aerosol cans under the driver's seat. Ever.

[Ace844]

Yoiu know, I'm gonna hijack the the thread here for a second, but this a good a place as any to share my tale of woe...

On Friday, a complex chain of events worthy of 'Final Destination' caused my partner to puncture an aerosol can of disinfectant when he went to adjust his seat, causing a high pressure stream of disinfectant spray to erupt into my face and eyes when I looked over to see what was hissing. Yes, temporary blindness, inability to open my eyes, all of that followed, and then, FOUR HOURS and several bags of normal saline later, I can safely say YES, I KNOW WHAT 0.9% SALINE FEELS LIKE IN YOUR EYES. IT was only halfway through that they blessed me with a few drops of tetracaine. Lucky for me it happened in the ER parking lot, and lucky for me there was nothing in the disinfectant that poison control thought was particularly dangerous. Don't leave aerosol cans under the driver's seat. Ever.

No tetracaine?!?!?!? 'ASYS,' what did you do to the nurses to induce this sadism? I hope your Ok, and no complications arise from this. It sounds like our luck is similar... Take care, and be sure to watch out for that fickled finger,

ACE844