As an EMT-I student on night shift this weekend, the medic had me put an NPA in a patient who was losing responsiveness but hadn't bought himself a tube yet. He held up fine and wound up not needing a tube. Later, the medic told me that she didn't really think much of NPAs, and actually used them more as a way to root out fakers than as airway adjuncts!

What do you guys think of NPAs? Have they proven worthwhile in the field for you, or does your airway adjuct sequence = nothing, then OPA, then ETT?

From a strictly technical standpoint, the NPA is the logical airway adjunct to carry if you're short on space; They're flexible, smaller than OPA's, and most importantly, can be used on a conscious OR unconscious patient.

My airway process would be: Assess patient...if he needs an airway and he's conscious, I definitely consider NPA. Not conscious, unresponsive, OPA until I get him to the truck, then replace OPA with Combitube and bag like there's no tomorrow until ALS arrives or we're at the hospital.

I would definitely consider an NPA as part of my airway continuum. However, I'm not actually an experienced medic. I need more experience to make that decision for field work.

I'm not out of school yet, but I see the NPA as having a place in my own home medical gear for just those reasons, where space and cost are at a premium and therefore maximum utility per unit is desired.

Panz

An NPA or preferably an NT maybe the only way to gain access in patients with clenched teeth. An NPA is better then nothing, if an OPA is not possible for a variety of reasons. I too have used an NPA for determining the level of conscious in an "unresponsive" patient <img src="/images/graemlins/smirk.gif" alt="" />. Pete

Good point regarding clenched teeth, Pete. The medic I was with was discussing NPAs in the context of being an EMT-P in our county, and EMT-Ps here can RSI if needed. So if she had a pt w/ clenched teeth, she would probably use RSI and tube them. Sounds like the NPAs have some value for us BLS-level folks.

Gee, so many TLAs (three letter acronyms)... hehe!

I like NPAs, and find that they are quite useful (usually more so than OPAs). Easy to insert & well tolerated by the patient (esp. when conscious <img src="/images/graemlins/wink.gif" alt="" /> ),

I'm very aggressive with my airway managment. I usually go for the OPA and than the tube. NPAs are not really that popular out here. The only time I've seen them used was in the ER (once). I mean they are good and would like to see them used more often but our protocols put more pressure and favor oral devices. And you try to be uniform by doing what other guys are doing as well. Since I only know about benefits of NPAs from the book I dont really know any practical field benefits.

Matt

Talked to one of my teachers regarding this subject. He admitted that when you're a Paramedic, and you've got All the Airway Toys at your fingertips, he goes from OPA to Intubation...

So I put it into perspective: "If you were packing a paramedic's bag you had to CARRY into the woods camping with you...would you choose to take the NPA's over a full Pharyngeal Airway set?"

He then reconsidered the utility of the NPA in a setting that wasn't so well-equipped, where space and weight were of the essence, and he said, "Ya know, that gives me an idea..."

He considered the OPA surperior for airway managment because of the tongue-depressing action of the OPA...but you can't get around 1) Small size 2) Packability (not rigid) 3) Light weight 4) Adjustibility in the field (cut the bevel of a long tube to length) and 5) Tolerance by both conscious and unconscious patients, all advantages of the NPA in a less-than-optimal field setting.

However...don't forget the lubricant. If you're going to go with NPA's, you need to bring along some Kentucky Jelly to make 'em slide in...

That could be a reason for preference right there. Must remember to ask.

Panz

I am a fan of NPA's. i find them very effective as a simple airway. They do work great for semi responsive poeple and will maintain if they go unresponsive.