CoTCCC updates NPA use, let’s break it down thanks to my favorite PJs! There is limited quality data to suggest that NPA’s are effective in trauma patients (most data is for OSA patients) and a further look shows we may be doing harm with NPAs that are not the right length. US military IFAKs do not match size to the person carrying them, instead it is a one size fits all (with varying sizes depending on where they are sourced from). The latest JSOM article (above) shows us that our traditional methods of measuring someone for an NPA aren’t accurate. Furthermore, in a study by M.D. Stoneham there is a 7% incidence of moderate to severe bleeding with placement. So maybe it is time to just use a more effective airway measure, the lateral recumbent position (already recommended but often overlooked).
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NPA Sizing: Ideal length will have the tip rest 1cm above the epiglottis. NPAs are sold by their French size (French size = 3X OUTER diameter in mm, so a 21 Fr is 7mm diameter). This also means that the French size is approximately the circumference as well. The majority of manufacturers/retailers list the French size and do not include an overall length which makes it difficult to determine if you have the right length. Too short of an NPA and you won’t separate soft palate and tongue, too long and you will gag the patient or hit the esophagus. What is the correct length? NPA Length (mm)= (Height (in) X 2.3241) – 15.38. Try doing that calculation on target!! Next best was the Nares:Tragus length (but it isn’t very accurate). Nares:Epiglottis length was an average 159mm in males, 140mm in females. When you use an average female and male height of 5’4” and 5’9” this gives a size of 133mm for average female and 145mm for average male. If you calculate it out, there is a 30mm size difference between a short female and a tall male, so one size does not fit all!
야매요약
-NPA 효과 좋음 근대 길이가 안 맞으면 오히려 해가 될 수 있음
-IFAK에 들어가는건 평균 사이즈 인대 그게 안 맞는 경우가 있음
-고전적 으로 쓰는 코끝-귓불 사이즈 측정도 무조건 정확하지는 않더라
-판매처 에서 통상적 으로 프렌치(fr) 사이즈로 표기하고 길이를 이야기 안 해주는대 그게 문제
-위에 표를 기본적 으로 활용하고 NPA Length (mm)= (Height (in) X 2.3241) – 15.38 라는 공식을 사용해서 정확한 사이즈를 찾으십쇼
+측정법을 사용해도 안 맞는다는 이야기가 아닙니다
다만 예외의 사례가 있어서 다시 연구해보니 공식을 이용해서 찾는게 정확하게 나온다는 이야기 입니다
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