Nasal intubation and no ventilatory assistance????

[AnthonyM83]

However, "Airway" and "Breathing" are not the same. In the same way "Oxygenation" (measured by SpO2%), "Respiration" (respiratory rate), and "Ventilation" (measured by EtCO2) are three completely different entities.

Are those descriptions of Ventilation and Respiration generally accepted?

I was taught Ventilation is the process of taking air into and out of of lungs (more having to do with air getting in/out) and Respiration is the exchange of O2/CO2 at the cellular level (at lungs and at tissues).

[VentMedic]

Are those descriptions of Ventilation and Respiration generally accepted?

I was taught Ventilation is the process of taking air into and out of of lungs (more having to do with air getting in/out) and Respiration is the exchange of O2/CO2 at the cellular level (at lungs and at tissues).

Correct AnthonyM83.

A ventilator can only move air in and out of the lungs.

ECMO and cardiac bypass perfusion machines are oxygenators and true respirators.

Oxygenation can be trended by SpO2 but a PaO2 is needed to determine oygenation and an SpO2 tells nothing about the A-a gradient.

ETCO2 can give some idea about ventilation but shunt perfusion and deadspace ventilation may have some influence on the numbers. The shunt perfusion may not affect the number for ETCO2 as much but may have an affect on the A-a gradient for oxygenation. Deadspace ventilation may widen the PaCO2 - ETCO2 gradient.

I prefer to look at Minute Volume or ventilation. Did the RR increase while VT decreased or did VT increase and RR increase or did both decrease or whatever combination. That is how I determine compensation or fatique. It may also tell me alot about the work of breathing of a patient.

Patients who are nasally intubated may work harder in attempt to achieve the same minute ventilation required to maintain homeostasis. The small diameter of the tube through the nare increases resistance, decreases ability to pull in a normal VT and will decrease VT thus increases the RR to maintain minute volume. Eventually you may get fatique if no assistance is provided.

[CTXMEDIC]

IMO, as written, this is an epic FAIL on your crews part. how drunk was this lady that she needed to have her airway 'controlled' ? we dont do 'almost', you either control the airway or you dont. IMO, this is at LEAST a suspension for the crew.

[crotchitymedic1986]

Well as usual, you know I will play devils advocate: Assumming that the patient continued to sat well, and was in no respiratory distress (proper rate, volume, color), is this really any different than a patient who has a trach collar, the opening is just a little further north ? Tube size is roughly the same as a trach (depending upon size they chose).

[chbare]

We are talking about a patient so intoxicated that nasal intubation was performed to protect the airway? The patient was vomiting as well and thus at high risk for aspiration prior to and during the intubation. Also, an ETT in the trachea does not totally prevent aspiration. In addition, saturating well may not mean doing well. Patient could be retaining Co2 like a champ. Finally, you can actually alter the dynamics of oxygen usage with high levels of ethanol. It can actually produce a type of hypoxia known as histotoxic hypoxia.

I would have a hard time assuming all is going well with this patient with the information provided. Especially well enough to allow the patient to breath through the ETT with a NRB mask placed over the tube. If the patient is in fact doing so well, perhaps we should go ahead and wean the patient from the tube on the way to the hospital? I bet Betty would be impressed with our mad RT skillz.

Take care,

chbare.

[VentMedic]

Well as usual, you know I will play devils advocate: Assumming that the patient continued to sat well, and was in no respiratory distress (proper rate, volume, color), is this really any different than a patient who has a trach collar, the opening is just a little further north ? Tube size is roughly the same as a trach (depending upon size they chose).

Trach vs ETT in the nose?

The nare can restrict the tube further increasing .

An ETT is several cms longer.

A trach is 6 - 10 cms in length. An ETT is approx 33 cms.

Do you know why is a patient is changed to a trach to facilitate weaning from a ventilator?

Basic math on this one. The FFs should also know this although they may not have calculated it since the academy.

Airway Resistance = (8 x viscosity x length)/pi x radius to the 4th power

The radius should also be considered at the narrowest part through the nare. A reduced airway lumen has a dramatic effect on airway resistance...hence the 4th power part.

A trach tube is more rigid and will maintain its radius throughout with the exception of secretions. A naso ETT will also risk bloody secretions which will further reduce the inner lumen.

Also if the mask is resting on the tube, the patient now has that resistance to overcome.

Increased work of breathing can cause other systemic effects that can lead to failure with more than just the respiratory system. It this patient is too deep in unconsciousness to meet the effort needed to overcome the resistance, failure can result from retained CO2 and the histotoxic hypoxia chbare described.

SpO2 tells you nothing about the A-a gradient or the SvO2.

An unnecessary nasal intubation may also result in antibiotic coverage and/or nasal packing which may not have been necessary otherwise thus prolonging a hospital stay in an already overcrowded hospital system.

[CTXMEDIC]

Trach vs ETT in the nose?

The nare can restrict the tube further increasing .

An ETT is several cms longer.

A trach is 6 - 10 cms in length. An ETT is approx 33 cms.

Do you know why is a patient is changed to a trach to facilitate weaning from a ventilator?

Basic math on this one. The FFs should also know this although they may not have calculated it since the academy.

Airway Resistance = (8 x viscosity x length)/pi x radius to the 4th power

The radius should also be considered at the narrowest part through the nare. A reduced airway lumen has a dramatic effect on airway resistance...hence the 4th power part.

A trach tube is more rigid and will maintain its radius throughout with the exception of secretions. A naso ETT will also risk bloody secretions which will further reduce the inner lumen.

Also if the mask is resting on the tube, the patient now has that resistance to overcome.

Increased work of breathing can cause other systemic effects that can lead to failure with more than just the respiratory system. It this patient is too deep in unconsciousness to meet the effort needed to overcome the resistance, failure can result from retained CO2 and the histotoxic hypoxia chbare described.

SpO2 tells you nothing about the A-a gradient or the SvO2.

An unnecessary nasal intubation may also result in antibiotic coverage and/or nasal packing which may not have been necessary otherwise thus prolonging a hospital stay in an already overcrowded hospital system.

Like i said. at LEAST a suspension, LoL.