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Old 11-17-2014, 19:02   #18
NurseTim
Guerrilla
 
Join Date: Feb 2011
Location: NM
Posts: 445
Quote:
Originally Posted by Stephens View Post
IMO, Some Excellent info from SurgicalCric. Also, I feel Okie is correct in advising caution to anyone using an NPA---especially in the field where things are much less controlled than in the OR.

This is true. We induce and then brush eyelash for reflex, then tape eye shut.
It's to answer the question "is this guy asleep?" Tape eyes. Muscle relaxant.

And yes, a NPA in a pt who is not deep enough can provoke brutal
Vomiting
Laryngospasm
Bleeding

Ask me how I know. Years ago, I had one huge guy I put a NPA in immediately valsalva and shoot a huge stream of green battery acid out of the NPA. He did fine but he could have aspirated and died.

I put an NPA in a lady in the OR once and she immediately started gushing blood. Turns out she had a history of terrible nose bleeds. I didn't ask her about that pre-op and frankly never expected to need an NPA for her--but I stupidly pulled the trigger and paid the price. She did fine with afrin and elevating her head but it slowed the case down.

Learn from my mistakes.
Take home;
They work great but I hesitate to pull the trigger on one unless I have to.
I've been in anesthesia (nurse) 10 years and an NPA will scare me.
I have low threshold for aborting insertion attempt if it isn't smooth as butter.
Would retreating with neosynphrine (spelling?) have prevented this? The bold portion I mean.
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