7-20-2015
The NPA NasoPharyngeal Airway 
This week’s Medic Shack tip of the week is on nasal pharyngeal airways. In the recent months more and more trauma kits are coming on the market with a NPA in them. Nasopharyngeal airways are a big help to a lot of people who are having trouble breathing on their own. However it needs to be kept in mind that the NPA only works WELL on arousable patients. if you insert an NPA into a unconscious unarousable or basically DEAD patient. It probably isn’t the magic you thought it was. You might be sadly disappointed. Now don’t get me wrong, they work very well on our unresponsive and semi responsive patients. However they just do not provide the same level of protection as their cousin the oral pharyngealoral airway. The nasopharyngeal airway go straight back into nasal carry and drops down to just in front of the pharynx but it truly does nothing to protect the lower airway. That being said lets get on with this show. My personal opinion on NPA is that if you have a patient that has compromised breathing, a NPA needs to be in place. Heck lets make it 2 of them if you are having to bag them. Even with it not working as well as its cousin, it is UNDER utilized. They are very fast to put in. With practice under 10 seconds is the the norm. They are safe, The complication list is short on versus the OPA and ET tubes. And they are in the BLS level of use. Meaning that anyone can put one in AFTER training. Lets get it in. LUBE IS YOUR FRIEND HERE. It doesnt have to be a perfectly measured 2.479 cc of gel a glob on the end of the tube and stick it in………..In a bit. Sizing the tube. I am going to break here and adopt the old EMT method of from the tip of the nose to the ear lobe. True. But you can grab the right size on the first try most of the time with this rule. Big adults – grab the 8-9mm (24-27 french). Regular sized adults get a 7-8mm (21-24 french). Small adults get a 6-7mm (18-21 french). Kids start at 5mm and work down. When deciding if a patient is “big” or “regular” use their height as a guide, not their weight. Patient height is the most accurate way of measuring the tube. Inserting the tube. Easy peasy. Lube the tube, FORGET about the old EMT textbook statement of putting the bevel towards the septum, (Middle of the nose). Why? Because the bevel is designed to work on the right nostril. Well what if it is plugged, tiny or it is just not there? How about this. Insert it in the largest nostril with the curve of the NPA oriented toward the mouth and forget about the bevel. When inserting it dont make a big production of wiggling it back and forth. Once or twice at the most. When it is to the middle of the tube, you can then gently push it in. The less fooling around with it, the more your patient will like you more. Less chance of nasal or sinus damage. The NPA is a GREAT tool. Know its limits. IE When it can and cant be used. And like the tourniquet, if you think you need it the use it. Also dont depend on the one size fits all in the handy dandy trauma kit. Have 1 of each size. And Oral Airways which will be a different topic