I would surely rank the nasopharyngeal airway (NPA) as one of the most under-rated / under-utilized pieces of equipment in the EMT bag of tricks. They’re useful, simple and versatile. As a group, we tend to do a pretty good job 
oxygenating our patients, but I think we drop the ball on BLS airway adjuncts.
Most of our unresponsive or semi-responsive patients should be arriving at the ER with an NPA in place. If you’re bagging a patient they should have one … maybe two NPAs in place.
They’re fast, they’re friendly, they work much better on the semi-conscious and they don’t stimulate the gag reflex quite like their cousin the oropharyngeal airway. They also stay in place better, leaving the mouth open for examination and advanced airway techniques.
I’ve often had EMTs explain that they didn’t drop a basic airway adjunct because they knew I was right around the corner and I’d be intubating. That’s a poor excuse. When I arrive on scene I’d like to see that the EMT at the head has managed the BLS airway aggressively.
So let’s bone up on our NPA skills. Once you’re comfortable with these little beauties, they only take a few seconds to drop. You don’t need to make it a big production. Grab the right size, squirt a clump of KY on the end and go.
So let’s break it down and make you an NPA, quick draw, master.
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Most of us have been there before. A puking, nearly unconscious teenager on our pram. All the 
predictable problems; airway issues, responsiveness issues, behavioral issues. When kids learn the hard lessons about alcohol and drugs we’re often the ones who get called in to clean up the mess. And, as tiring as the routine gets, we do what we can.
We protect the airway, administer our oxygen, start the IV, monitor the capnography, pay attention to the heart rhythms, the whole kit-n-kaboodle. (You may use another term … that’s just me.) The subtleties of treatment change with level of certification and protocols, but the call runs remarkably the same.
Some medics is Tulsa, OK decided that we run this call far to often and they got the bright idea to see if they could change that dynamic. Today in high school classrooms around Tulsa EMT’s and Paramedics are taking their kits and prams into the classrooms to talk to teenagers about just what it’s really like to be laying on that pram after an alcohol or drug use mishap.
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Since we’ve been talking about the fill the boot campaign the annual MDA telethon, why not use our “what is” series to take a closer look at the group of diseases we commonly refer to as muscular dystrophy.
While most EMS caregivers have a general idea of what to expect in a muscular dystrophy presentation, few of us are as knowledgeable as we should be about what muscular dystrophy is and what it does to the body. Let’s take a closer look.
While we tead to refer to muscular dystrophy as a single defined disease process, it is actually a group of disease that share some common characteristics. Add to that the fact that all of these diseases are degenerative in nature and you can imagine how remarkably different these patients can be.
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Part three of a three part series
In our last two installments we looked at the way heads get injured and the various ways the brain tends to bleed. In this, our last installment in the head injury series, let’s take a look at basic treatment and management of the head injury patient.
There are a lot of variables that need to be considered when managing a head injury patient in the prehospital environment. Your treatment will be guided by considerations like the mechanism and severity of the head injury, other associated injuries, the patients mental status and their basic stability.
These are some guidelines when sizing up and prioritizing your care.
Airway Management:
Head trauma management begins with the airway. The brain is sensitive to hypoxia and a poorly managed airway can turn a significant but recoverable head injury into a devastating head injury. Our brain injured patients can present some unique airway challenges. Seizures and posturing can produce trismus and spinal precautions prohibit proper tilting of the head.
In these cases, oral and nasal airway adjuncts are helpful in ensuring proper ventilation while keeping the head midline and neutral. If the Glasgow is less than eight, consider an advanced airway like a king tube, combi-tube or ET tube. All of these should be protected from the possibility of a clenched jaw with some sort of bite block type protection.
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We all have our good calls and our bad calls. Don’t we? Sometimes things just flow. Sometimes the patient, the bystanders, the crew members, everyone just clicks. And it’s beautiful. It’s like that perfect drive off the tee box that keeps you coming back for another round. The three point jumper that makes you wonder if you should have tried to play college ball.
Unfortunately (perhaps) it is the rare scene that runs flawlessly. More often than not we look back on our calls and think about the things we could have, and should have done better. Of course, that’s how it should be. Without those moments we don’t grow or become better. Some EMT’s carry the philosophy that we should emerge from our field instruction with flawless medicine. Nothing could be further from the truth.
Here is my list of five common trauma scene mistakes I have encountered frequently in my career. I am guilty of doing all of these, some with painful frequency. In those moments of personal scene review, I rank these as my top five, “I wish we had done that differently.” items.
#1 Failing to manage the scene.
We learn a lot about patient care in school. Unfortunately our education regarding management of the scene may be limited to being taught to blindly recite the words, “Scene safe, BSI” as we enter our skills stations. Scene management can be hard. Especially management of big scenes with multiple priorities like calling for more resources, assessing hazards, protecting bystanders, interacting with family and friends of the injured and triaging multiple patients.
On these scenes, patient care suddenly becomes a warm comforting blanket. Caring for one patient seems so much more manageable. Patient care priorities like holding c-spine and doing an assessment call to us like a sirens song. Don’t do it! It seems obvious but, when it’s your job to manage the scene, manage the scene.
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Treatment Guidelines For The Burn Patient
You’ve taken an educated guess on burn depth, calculated the burn area and classified the burns severity. With those priorities out of the way we can start treating the victim. (Yes, I’m taking some creative literary licence here, since assessment and treatment tend to occur in tandem.)
There are things we tend to do well and things we tend to do poorly in prehospital burn management. Here are some “do and don’t” type guidelines to direct your burn treatment.
Always consider the possibility of non - accidental trauma in pediatric burns.
Do:
Assess the heck out of the Airway.
- Inhalation burns are easy to miss if you’re not paying attention. Burn victims have a tendency to gasp when they are burned. You need to look really close at that airway. Shine a light on the patients facial hairs (yes women have them also) and look for singed or missing patches. Look up their nose and in their mouth for evidence of burns.
- Listen to the lungs and auscultate over the trachea. Reassess frequently. Only time will tell for certain if there is damage to the lower airway or lungs. Until then, you need to reassess frequently and don’t get caught behind the eight ball trying to manage an airway that goes down hill due to unrecognized burns.
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