Nasopharyngeal Airway (NPA)

Tom RaderStaff - June 1, 2021

Did not have any content for here since we decided last minute to do this video.   TKTKTK Content   Dispel myth of basal skull fracture.
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Is it accurate to say that it’s prudent to use an NPA whenever a patient’s nose/mouth/airway have been hit hard? Are there specific symptoms that we should first check for, like non-normal breathing, or something else?

 

This is a good example of where overly-specific checklists can get in the way of common sense or how varied these scenarios can be. 

The key trigger is: Do you have reason to think the patient’s upper airway could close? If so, use an NPA, especially because it’s non-destructive, easy, can be used on conscious patients, etc.

That almost always means there was some kind of trauma, such as smacking their face on the steering wheel during a car accident. I wouldn’t put an NPA in someone just because the air bag deployed… there would be some other kind of indicator, such as leaky fluids or pain or squishiness in the bones when you touch their face. But it all comes down to your judgment.

As a counter example: Someone might be struggling to breath because of an allergic reaction closing their throat. In that case, an NPA isn’t going to do anything because, even if you keep the upper airways open, their throat will still close. 

 

Does the lube normally come with the NPA or is it purchased separately?  More critically, what is the shelf life of the lube?  How frequently do I need to replace it if it hasn’t been used?

 

It’s assumed the lube comes with the NPA. As long as the lube packaging is intact and you don’t see/smell anything obviously weird, you’ll be fine using it. Replace it once you think “gosh it’s been like 5-10 years since I bought this.” I’m not aware of any shorter-term shelf life than that.

 

Also wondering:  What are the typical scenarios beyond, as mentioned, car accidents where an NPA is commonly used?

In terms of what to carry or not carry in my various FAKs, my inclination is that an NPA would be worth including in my vehicle FAK but not something that makes sense to carry in my FAK for hiking, snowshoeing, or backpacking.  Given that NPAs are close to the bottom of the Prepared’s IFAK list, beyond the baseline 80-20 prep, I’m guessing they are not used all that often anyway.

 

Yeah, the general vibe is that they aren’t used all that often. For example, when investigating the “you can puncture the patient’s brain” myth, we’ve asked a lot of pros about the number of times they’ve used one in the field — and the answer is usually 0-3 out of thousands.

Other relevant scenarios would still have a similar ‘mechanism of injury’ to a car accident, in that blunt force trauma has crushed the bone structures around the upper airway. This could be from smashing your face into the steering wheel, or from falling down a cliff during a hike, or bothering Mike Tyson on a plane until he socks you in the nose. So it theoretically could be useful outside of a vehicle kit, but I personally don’t bother in those contexts because I know I’m sure-footed and don’t do crazy stuff on trails etc.

p.s. sorry for lag in responding to your questions! We were out with covid when they came in.

 

We almost never used them professionally in the field, as paramedics we had better airway things: intubation tubes, LMAs, etc. I don’t include NPAs in my personal kits even now. I think they’re just overly specific and basically unneeded. 

And as far as putting them in an conscious patient? No one, especially the patient, is going to be happy about that — especially if it’s put in by someone inexperienced.