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Old 09-29-2014, 22:39   #16
steel_eel
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Originally Posted by Defend View Post
Only other question is can anybody recommend a military friendly medical supply shop to do business with in the Hampton Roads area?
Have you checked out Double Tap Surplus? They mostly have hemorrage control items but it wouldn't surprise me if they have NPAs/Airway items now.
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Old 11-16-2014, 14:30   #17
Stephens
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Originally Posted by Surgicalcric View Post
Speaking of half trained...that is incorrect.

The Facial Nerve (CN V) mediates the corneal (eyelash) reflex and the gag reflex is mediated by the Glossopharyngeal and Vagus (CNs IX and X) nerves. These nerves do not share any common pathways and the presence of one does not imply anything about the other. Anesthesiologists often times will utilize the method you outlined to gauge alteration in gross sensory function from a known baseline. There is a correlation (although not perfect) between unconsciousness and loss of gag, so there is some value in the lash test for that but using it in the field while suggestive, isn't the same.

The history of the lash test is that in the OR after administration of an induction agent, the anesthesiologist would lightly brush the eyelashes to check for a blink. The reasoning behind this practice is not so much to check for a gag (going to make that go AWAY!) but to check for unconsciousness prior to the administration of a neuromuscular blocking agent. If no blink is present, the anesthesiologist could be reasonably certain they were not paralyzing a patient who is "awake".
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.
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Old 11-17-2014, 19:02   #18
NurseTim
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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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Old 11-18-2014, 20:45   #19
Stephens
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Originally Posted by NurseTim View Post
Would retreating with neosynphrine (spelling?) have prevented this? The bold portion I mean.

For most patients, it can make a huge difference (Neo syenephrine or afrin).
This lady was a special case--history of bad nose bleeds.
We did use afrin on her prior to insertion but wasn't enough.
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Old 11-18-2014, 20:55   #20
Stephens
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Originally Posted by Brush Okie View Post
Sounds like you learned the same way I did.

Yes. The hard way.
NPA is worth it when your back is against the wall.
But I never force them--
Give afrin (BOTH nostrils)
Wait
Wait
Gently attempt insertion-rotating as needed, seeking the best angle
If no go, try the other nostril.
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