IFAK Essentials Series: The NPA and OPA (Updated)

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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IFAK Essentials Series: The NPA and OPA (Updated)

Post by Gunny » Thu Mar 27, 2008 9:16 pm

For this installment of my IFAK Essentials Series: The NPA & OPA, JIM (a career ER nurse) has offered his medical expertise to write an excellent article regarding an essential function every medic should know: how to protect a patient's airway. JIM wrote this article in it's entirety, so Kudos to him! I've tweaked the format slightly and added more information/links/pictures. Look for this installment of the IFAK Essentials Series to show up as a ZSS Feed Article soon.

In a survival situation, traumatic injuries will occur and on occasion, this means you will have to protect the patient's airway (or establish one in the first place) to ensure your patient's survival. Now that you understand the importance of understanding how to use these simple and inexpensive IFAK Essentials, lets launch into the meat of the argument, the how/when/why their use.

This article will focus on two lifesaving implements, the Naso-Pharyngeal-Airway (NPA) and the Oral-Pharyngeal-Airway (OPA). These instruments are used for the airway-management of a patient. If you know how to use one, they should belong in your Post Apocalyptic World (PAW) First Aid Kit (FAK) or trauma-bag and with a little training and this article, you can better equip yourself to save lives.

Below is a diagram of a normal, unobstructed airway. Try your best to memorize the basic functions of this airway as it's absolutely vital to protect this

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A OPA or NPA prevents the tongue from falling back into the pharynx and blocking the airway. This could happen when the muscles in the mouth are relaxing:

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^Now you could open the airway manually, using the 'Chinlift' and 'Jawthrust'- methods as demonstrated in the picture above, but of course you can't treat other injuries/people when you've gotta keep someone's airway open. This is where you use a NPA or OPA for. Source for Chinlift and Jaw Thrust technique

First, let's take a look at the NPA:

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^The NPA is important enough to be issued to most US military members thanks to their new Improved Individual First Aid Kit Source in PDF

The NPA is a piece of flexible tubing that is inserted into the Naso-pharynx:

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This can secure the airway, because when a patient becomes unconscious, the muscles in the jaw relax and can allow the tongue to slide back and obstruct the airway resulting in suffocation and loss of the patient.
A NPA prevents this, though not as well as a OPA which I'll cover later.. So this begs the question: When do I use a NPA and when not?

WHEN TO USE

The NPA is used on conscious people because there’s a smaller gag-reflex (which can cause vomiting) with a NPA than a OPA. A NPA also has less tendency to fall out, so it is preferred when transporting a patient or in tactical-conditions. Also, at times you won't be able to place the OPA due to potential alternative injuries to the patient (for example if the patient is suffering from lock-jaw)

WHEN NOT TO USE

- Suspected skull-base fractures (we don’t want to poke the NPA directly into the brain, now do we..)
- Severe facial trauma (like when you can’t find the nose anymore).
– Nose-bleed (because blood will get into the NPA, rendering it useless)

A thing that also could go wrong when inserting a NPA is that you hit the Vagus Nerve. This nerve regulates the parasymphatic-processes. IOW: It slows your body down. When this nerve is triggered, people can get a very slow heartbeat, become dizzy and could faint for a couple of seconds. This is called a vasovagal syncopy and it will go away on itself.

INSERTION

Hold it buster, before we try to jam a NPA into someone’s nose, we need to choose the right size NPA. Measurement of a NPA is done in ‘French’ (F), which is also called a ‘Charrière’ (Ch). 1 F/Ch is 0.3mm. Sometimes their also called 6-0 or 7-0, which stands for a thickness of 6 or 7mm. NPA’s can range from 20F to 36F.

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^The average NPA-size for a adult is 28F, however you should make sure that you’ve got the right size before inserting them, and here’s how you do that. There are 2 methods. The first one is that you hold the NPA on the cheek of the victim. The NPA should reach from the tip of the chin till the earlobe.

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^Second way is from the tip of the nose till the earlobe. If the NPA's length looks like this, you're good to go.

A NPA usually comes with a small sachet of lubricating-gel. This is put on the NPA to make the insertion easier. Sometimes you can also use spit. Don't be squeamish, this is your patient's life on the line, set aside your queasiness.


Below is a pictorial representation how to insert a NPA (after you measured it): Orient the bevel end on the NPA so that it will pass along the inside of the nasal cavity with minimal effort and insert the NPA until the flange (the large end of the tube) is seated on the patient's nose.

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WHERE TO BUY:

SPSERVICES (UK website)
NARESCUE
CHINOOK MEDICAL
LIFE MEDICAL SUPPLIERS
MED-WORLDWIDE (Global shipping)

EDUCATIONAL RESOURCES

Planet CNM, Educational Resource for the NPA
University of Virgina: Airway management tools
Youtube Video of proper NPA insertion by Army Medics
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^Our own Doc Simon being intubating with an NPA while serving in Afghanistan.




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The OPA:

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The Oral Pharyngeal Airway is also called a ‘Mayo-tube’ , a ‘Guedel-airway’ or sometimes a ‘J-tube’. This sort of airway is used on unconscious people (which don’t have a gag-reflex anymore). They can be used with skull-base injuries and have a lesser chance of triggering a vagovagal syncope.

However, you’ve got to get the size just right because a wrongly inserted OPA can block the airway even further or cause bleeding. A OPA also takes a bit more thought to insert than a NPA.

The sizes:

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They also have a number, indicating the length of the OPA. For example, a size 1.0 OPA, is 10cm long. A 0.9 OPA is 9cm. long, etc. The problem it that there's also another size-system, which is shown in the above picture. Here, a red, 1.0 OPA is referred to as a size 4. I've got no idea why..


HOW TO MEASURE THE OPA

This is how you measure the correct size OPA on a victim:
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You could also use this method:

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INSERTION

Keep the mouth open by putting your thumb onto the bottom-teeth. Insert the OPA as shown in the picture. When it’s about half-way in or when you feel the tip of the OPA hitting the top of the oropharynx, turn the tube 180 degrees, so that the tip now points to the throat.

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At this point, rotate the OPA 180°

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Here's a good video of the OPA as used in operational medicine (may take a little while to load): WMV File, Right Click, Save As

WHERE TO BUY:

SPSERVICES (UK website)
CHINOOK MEDICAL
LIFE MEDICAL SUPPLIER
EBAY

EDUCATIONAL RESOURCES

Wikipedia
Rn Web article outlining proper placement
Pictorial Demonstration of OPA use
Youtube Video showing OPA insertion
Youtube Showing how quick and easy OPA insertion is with a bit of practice


So that’s it. When you know the how, when and why of the NPA and OPA airway devices. These two items are essential pieces of kit for any serious trauma medic and thanks to their ease of use, can and should be added to any trauma bag/kit you may have.

Thanks for reading, class dismissed.
Last edited by Gunny on Sun Mar 30, 2008 6:24 pm, edited 2 times in total.

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Post by MS8725 » Fri Mar 28, 2008 3:57 am

Great info. I may have missed it but when you use the lube on the NPA it should be WATER based not petroleum jelly or vaseline. Especially if you are using supplemental O2... at least according to the Protocols my service uses. I know most EMTs know this but I have seen an Intermediate try to use vasekine. Spit... eeww, I'd never get away with that one but I will keep it in mind.
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Post by Jamie » Fri Mar 28, 2008 5:11 am

Thanks,

I got one of these in a surplus FAK that I ordered, and while I don't think that I'd pack/use it (given my no training in this stuff), it's nice what it is...

great fak posts Gunny!

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Post by JIM » Fri Mar 28, 2008 5:47 am

MS8725 wrote:Great info. I may have missed it but when you use the lube on the NPA it should be WATER based not petroleum jelly or vaseline. Especially if you are using supplemental O2... at least according to the Protocols my service uses. I know most EMTs know this but I have seen an Intermediate try to use vasekine.
Your right about the lubricating jelly, but since most NPA's come prepacked with a small sachet of the stuff, I didn''t mention it.
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Post by MS8725 » Fri Mar 28, 2008 6:28 am

fair enough
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Speak what we feel, not what we ought to say."-Edgar, King Lear

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Post by Gunny » Sun Mar 30, 2008 4:32 pm

Finished editing. I've tweaked the format, added more sources for purchase as well as educational resources (to include several videos and PDF files) one of which featuring our own Doc Simon :)

Lemmie know what'cha think and thanks again JIM.

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Post by Jorian » Tue Apr 08, 2008 2:55 pm

Really enjoying your series, Gunny. Thanks.

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Post by The Syndicate » Tue Apr 08, 2008 5:56 pm

Jorian wrote:Really enjoying your series, Gunny. Thanks.


+1

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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by Ellie With An Axe » Sat Aug 15, 2009 11:47 am

Great info! Although we were taught to use these in class, it was "unofficial" so I'm not actually trained to use them yet. Although I was trained 15 years ago in my EMT class, I never tested out, so I don't think I should try to use these airways on my own. Still, I'll eventually put a couple of sets in my kit in case someone else can use them.

Also? Waking up with an OPA still in is no fun.

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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by DeltaUpsilon » Sat Aug 15, 2009 12:51 pm

Great post Gunny, thanks. I also dub the trainee in that NPA video "fumbles" for his handling for the NPA. :lol:
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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by Erik » Sat Aug 15, 2009 9:45 pm

I have both in my IFAK. However, my EMT instructor told me NPAs are rarely used. Apparently, people who are conscious are almost always able to protect their own airway. As soon as they go unconscious, the gag reflex goes away and you can use the OPA. Not saying there's never a situation where they won't be used, but my instructor said he's used only one NPA in 23 years.

If you can only stock one, stock a set of OPAs.

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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by JIM » Sun Aug 16, 2009 2:33 am

Erik wrote:I have both in my IFAK. However, my EMT instructor told me NPAs are rarely used. Apparently, people who are conscious are almost always able to protect their own airway. As soon as they go unconscious, the gag reflex goes away and you can use the OPA. Not saying there's never a situation where they won't be used, but my instructor said he's used only one NPA in 23 years.

If you can only stock one, stock a set of OPAs.
True, the main use for NPA's is in a tactical situation when an OPA takes too much time to insert and gets dislodged easily. However, they do work great on people that don't want to be cooperative with EMS and play beeing unconscious... :twisted:

An NPA attachted to a catheter-tip syringe also works as an improvised suction device..
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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by 0122358 » Mon Jan 06, 2014 12:57 pm

Finally a good resource on how-to use these
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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by Gaelin » Sun Mar 30, 2014 10:12 am

I always wondered what those two j-hook looking plastic pieces were in my FAK. Now I know. Thanks to Gunny and Jim I learned something new from zombiesquad. That's what I like about this site.
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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by Calzonewdippingsauce » Sun Mar 30, 2014 10:46 am

Erik wrote:I have both in my IFAK. However, my EMT instructor told me NPAs are rarely used. Apparently, people who are conscious are almost always able to protect their own airway. As soon as they go unconscious, the gag reflex goes away and you can use the OPA. Not saying there's never a situation where they won't be used, but my instructor said he's used only one NPA in 23 years.

If you can only stock one, stock a set of OPAs.
They do work great for people who are one that "edge." Kind of like the postitcal seizure patient who still has an intact gag reflex but is pretty out of it. The semi conscious alcohol or other drug overdose patient who still has the intact gag reflex. I also recently had a gentleman who suffered a stroke who was also in need of some minor airway support with which this worked great.
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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by Veritas » Sun Mar 30, 2014 3:59 pm

I kinda feel like if you tolerate an OPA you should probably get an ETT. I only use OPAs when we are having difficulty bagging someone just before intubation.

I like NPAs for conscious people.
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Re: IFAK Essentials Series: The NPA and OPA (Updated)

Post by cap6888 » Sun Mar 30, 2014 7:08 pm

Veritas wrote:I kinda feel like if you tolerate an OPA you should probably get an ETT. I only use OPAs when we are having difficulty bagging someone just before intubation.

I like NPAs for conscious people.
I agree wholeheartedly. Especially with King airways being so prevalent now. If they can take an OPA, they can take a King, henceforth they can get tubed. Unfortunately, I see most newer medics in my jurisdiction going straight to Kings because it was so easy. They don't realize they are letting their skills degradate by taking the quick, easy route. Just my opinion though.

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