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Okay, when I did the first-responder training way back when, the instructor was really big on nasopharyngeal airways - NPAs - for securing airways, because any idiot and their mother can insert one successfully, as opposed to, um, the oral tube airway (OPA?), and they stay "in" a lot better than the hard plastic (Berman?) airways. Now, he only touched on them really briefly, because we were training to be first responders, damnit, not EMT-Bs, and NPAs are kind of "above and beyond".
That said, I carry far more medical and first-aid supplies on me when exploring than is probably necessary, because, well, shit happens. I've got a set of the hard plastic airways, but I was looking to replace them with NPAs. Only thing is, I'm way confused about the sizing on these puppies. "20fr" to "32fr"? What the hell's that all about. I don't recall the ones we were taught on being marked in any way; we were taught to pick the one just smaller than the patient's little finger, and use that. Assuming "20fr" is the smallest, I could probably go with a couple of those, but I have no clue if this is moderately sized, or pediatrically-sized, or what.
I've searched Google, but that wasn't much help, so if any of you folks have got a clue as to what the fuck wierd-ass metric sizing system NPAs use, or a recommendation as to what size(s) is(are) (a) safe bet for average adults... lemme know. 
On an unrelated note, since this is a really dead forum, self-adherent gauze is proof the Gods love us and want us to be happy.
Have Speed Graphic, Will Travel. | |
I'll tell you what, I'll ask my EMT instructor about it, but I've never heard of metric sizes for NPA's.
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Well, what sizes *have* you heard of for NPAs? When I search Google, or Froogle, for instance, every site that comes up seems to be selling them in sizes from 20-32 or thereabouts. I was trying to figure out what the numbers could signify, but I'm stumped.
NPAs seem like a really great alternative to Berman-style "I-beam" airways for cheap and easy airway management, but I really don't want to buy a full set of the damned things to get a few usefully sized ones. <shrug>
Have Speed Graphic, Will Travel. | |
The one's we used were 6.0, 7.5 and 8.5. This refered to the outside diameter of the NPA in millimetres. The Fr or "French" term is still commonly used for suction catheters but in my years on the road, NPAs were never refered to as Fr...but then again, Canada is Metric. Our OPAs used to be sized 0 to 6 but this changed over to metric with a 4.0 being infant sized and 12 cm was the old #6 sized.
[last edit 1/22/2005 5:15 AM by Father Maurice Lester - edited 1 times]
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So far, all I know of are the three sizes we carry on the Engine: Infant, Child, and adult NPA's. I haven't had much experience with it so far, though.
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I have no idea how the sizes work either, ive seen the Fr and regular....
But for your info... OPE is Oral pharyngeal Airway.
And i like those better myself.. Only thing that is better about NPA then opa's is that you can use them if their still conscious and their gag reflex is still intact.
"Government is not reason; it is not eloquence; it is force. Like fire, it is a dangerous servant and a fearful master."
"There's no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren't enough criminals, one makes them. One declares so many things to be a crime that it becomes impossible to live without breaking laws." | |
OPA*
"Government is not reason; it is not eloquence; it is force. Like fire, it is a dangerous servant and a fearful master."
"There's no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren't enough criminals, one makes them. One declares so many things to be a crime that it becomes impossible to live without breaking laws." | |
Just carry a whole set 
I carry a kit that meets the Ontario Ministry of Health standards for a BLS ambulance trauma kit. It calls for NPA's in 26Fr, 30Fr and 34Fr. OPAs are 50mm, 55mm, 60mm, 70mm, 80mm, 100mm and 115mm.
They really take up no space at all.
Unit calling radio say again? | |
Yeah I'm not sure about the specific sizing by numbers, we just size them manually based on the person they've got to fit.
You're missing some info about OPA's and NPA's though. One doesnt "replace" the other, they're for different uses and situations.
As mentioned, you wouldnt use an OPA in a conscious patient, they're ONLY for use in unconscious patients.
And if a patient had trauma to the nasal passages of some sort, you wouldnt use an NPA anyway, but if they had nasal trauma and were unconscious you could still use an OPA.
Likewise, for a patient with oral trauma who was unconscious you still wouldnt necessarily use an OPA, because an NPA might be more appropriate.
They're only adjunct airways, they dont replace the use of an ET or similar device, they only assist in opening an airway when using the normal BVM cup isnt getting air to the lungs for some reason.
And while NPA's are more convenient and "easier" to use, they can still cause trauma on their own if you arent carefull about inserting them, or if you dont lube them up right first.
I've had an NPA stuck in (just for fun, at the ER) and they feel really flippin wierd, but they provide a great passage for air flow through the nasal passages, thats surely true.
Give a person a match and they'll be warm for a minute, but light them on fire and they'll be warm for the rest of their life. =) | |
All my NPA's and OPA's here are metric sizes based on external diameter in millimeters. I get sent a lot of 'care packages' from serving guys, the measurement system is similar to exkaliburs.
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Also remember not to use a NPA on suspected spinal/head/brain injuries..
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Wow, this is an old thread
Like Therrin stated, the nasopharyngeal airway isn't a replacement for the oropharyngeal airway, or visa versa. They each have their own very specific uses.
Its a common misconception that an NPA protects the airway the same way and to the same extent as an OPA. This is NOT true. An NPA merely assists in ventilating - that is, giving you a patent path from the nasal cavity onward and up to the oropharynx, provided that the patient is alert and/or securing their own airway. An NPA does NOT prevent the patient's tongue from occluding the airway by dropping back against the posterior oropharynx, which the OPA, on the other hand, is designed to protect against. This is why you use an NPA in a conscious patient or one with a gag reflex, and an OPA for any unconscious/no gag reflex. No gag reflex = no muscle tone = tongue against posterior oropharynx. The OPA should always be the first choice if advanced management is unavailable and the patient meets criteria (negative gag reflex).
The presence of a gag reflex can be checked pretty easily by doing a "lash test". Brush your fingertip lightly across the eyelashes of your unconscious patient. If this causes a twitch, this is indicative that they DO have a gag reflex. Remember - NO gag reflex = OPA, YES, = NPA
Do not use an NPA on any patient with mastoid ecchymosis and/or other ominous signs of basal skull fracture or any condition that could potentially allow passage of the airway into the cranial cavity.
I have never heard of the "pinky" sizing method that was mentioned. NPAs are classified according to a specific sizing index called the French scale. This is a reference to the outer diameter of the airway. Some manufacturers also specify a size in millimeters along with the standard French size. In Canada, we commonly utilize the millimeter measurement, as opposed to the French sizes. Typical sizes are 6.0, 6.5, 7.0, 7.5, and 8.0
NPAs are typically sized by placing the tip of the airway at the outer edge of the nostril and extending it outward to the lower tip of the earlobe on the same side of the head. This method ensures a perfect fit nearly every time. Rarely, you may end up having to go one size smaller than the initial measurement if you find the airway is slightly too large in diameter, usually to account for slightly abnormal nasal architecture.
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*thumbs up* A well-worded and thoughtfully orated review.
Give a person a match and they'll be warm for a minute, but light them on fire and they'll be warm for the rest of their life. =) |
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