OPA and NPA use

[PRPGfirerescuetech]

combi tube is intubation, as it establishes a direct pathway into the trachea.

dont take yourself so seriously, guru.

Actually, according to our good friends at google, who showed me several airway articles...

Combi-tubes are listed in just about every article as an "airway adjunct" similar to OPA, NPA, and LMA.

Establishes pathway, yes. Has the same connotion of skill level associated with intubation, no.

Lets remember, the word "intubation" refers to the actually skill.

[Guest]

I f the Combi tube goes straight to the trachea as you stated, how do you know? The combi tube is a blind insertion and chances of getting it in the trachea are approximately 25%. The only way to tell if it's in correctly is by bagging the pt. If the stomach inflates, your in the esophagus.

[PRPGfirerescuetech]

I f the Combi tube goes straight to the trachea as you stated, how do you know? The combi tube is a blind insertion and chances of getting it in the trachea are approximately 25%. The only way to tell if it's in correctly is by bagging the pt. If the stomach inflates, your in the esophagus.

Likely why its considered an adjunct...

[medic001918]

combi tube is intubation, as it establishes a direct pathway into the trachea.

dont take yourself so seriously, guru.

If anyone should consider not taking themselves so seriously, it might be yourself. My guess would be that since you're still a student in EMS, you have MUCH to learn and that the vast majority of people here might have an idea as to what they're talking about. But using the combitube is NOT intubation. Actually, for paramedics the combitube is considered a "rescue" airway to be used when intubation fails. The fact that you can use a combitube but not truely understand how it functions, or the anatomy of the airway from your class is rather discouraging. You are going to be able to perform a skill that you don't really understand. The majority of being a good provider is to have an understanding of what you're doing, how it works and why you're doing it. I have a strong feeling that you lack at least one of those key pieces. Hopefully that will be corrected by the time you're on your own in the field.

Shane

FFI/NREMT-P

[akroeze]

I'm not sure what's up with the right nostril thing. I've heard that you should start with the right nostril. I just looked and it says that in the 1994 Brady Paramedic textbook. But it doesn't explain why, and I've never been taught that in medic school or nursing school. I just did a pretty extensive Google search and couldn't find any other references to this.

Well what I was told when I was trained is that the right nostril tends to be slightly larger than the left and a straighter path too I think (??)

[Pose]

I was told that as well. I Googled it, skimmed through two anatomy atlases, and looked on a few manufacturer's sites and came back with nothing. It may also have something to do with the fact that most NPA's are made with the beveled edge on the right, and it's simply more convenient to attempt that side first? Couldn't tell you why, though. I doubt my instructors could either.

[AZCEP]

The right nostril has two turbinates, the left has three. The difference is the amount of trauma that you can cause to the capillary bed in the side that you choose. NPAs are manufactured with the bevel where it is for this reason. You can use the left, but you need to insert the NPA reversed until you meet resistance then rotate it into position, much like an OPA. Judicious lube, and a little neo synephrine limit the bleeding that you will cause.

The dry NPA is a really good painful stimulus to the unconscious patient that you don't feel too compassionate for.

[Guest]

PRPG, I was agreeing with you. Just pointing out to Opera Ghost some facts about the combi tube :wink:

[PRPGfirerescuetech]

PRPG, I was agreeing with you. Just pointing out to Opera Ghost some facts about the combi tube :wink:

i know..apologies if i came off with any sort of attitude

[DartmouthDave]

Hello,

I agree with the good points reguarding NPA (suctioning, tolerance, ect....) However, OPA are better in

certain situations.

1. Basal Skull #

2. Pt. on anticoagulants, and anti-platelets (ASA, Warfarin, Heparin, ect...) because they may bleed

allot!! (learned that the hard way one) Now a unsecured airways is full of blood =(

3. CVA pt. who may be in the window for TPA, ect..... They will bleed once the clot is busted from everywhere

a laceration is. =(

Thanks,

David