Archive for the ‘medicine’ tag
oral pharyngeal
Now before you run away thinking you know all there is about the OPA, take a minute and read on.
The use of the OPA is one of the first skills used in most EMS training. It helps to secure the airway of an unconscious patient using basic methods and allow for better oxygenation of the patient.
Too many times though many providers simply use a one size fits all approach when placing an OPA. This has a few drawbacks and I think you would find much better outcomes with your patient care if you take a few extra minutes and select the appropriate size for your patient.
The Basics – an oral airway is a device that lifts the tongue off the posterior pharynx, many times making it easier to ventilate a patient using a bag valve mask. The inability to ventilate a patient is bad. Also a source of O2 with a delivery mechanism (ambu-bag and mask) must be available.
The oropharyngeal airway is only used with an unconscious patient.
Do not insert the oropharyngeal airway if the patient is conscious or semiconscious. The OPA could cause the patient to gag and vomit.
If you have an unconscious patient who becomes conscious remove the OPA.
Now I won’t go too much into detail on placing an OPA but I do want to mention a few of the possible negative outcomes by using an OPA especially if not sized properly.
• Should the patient have a gag-reflex he/she may vomit
• If you use too large a size, it can close the glottis and thus close the airway
• Too large a size may cause bleeding in the airway
The above three scenarios are the main drawbacks and I think the primary reasons for taking the time to size an OPA properly for each patient.
If the patient is conscious or semi conscious and vomits the danger in this is that the patient could inhale some of the vomit which could then obstruct his airway.
If the airway is not the correct size, it could injure the patients throat or even obstruct his airway. The right size keeps the patients tongue from falling down the back of his throat.
As a quick overview I want to just go over proper sizing of the OPA.
1- Place the oropharyngeal airway along the outside of the patients jaw with one end of the airway at the bottom tip of the patients ear.
2 – Make sure the patients mouth is closed and bring the other tip of the airway toward the corner of the patients mouth.
3- The airway should reach from the bottom tip of the patients ear to the corner of the patients mouth.
4- If the chosen OPA is too small or too large simply repeat the steps using another oropharyngeal airway and choose the one that is nearest the correct size.
Taking these quick steps will help you not only prevent incorrect sizing and possible complications. They will also help you ventilate a patient much more effectively improving your patients overall outcome.
As with anything else, by doing it on a regular basis, you will see that it becomes easier and that you can perform the task quicker.
The A-Z series tries to promote the basics in EMS and while articles like this may appear boring, they are the backbone of what we do in the field. Having a firm understanding and knowledge of skills such as this will guarantee that your advanced skills and training is put to good use.
Animated Tonsillotomy with the Lumenis Oral Pharyngeal Hand Piece