Nasal intubation

[Barefootedkiwi]

Nasal intubation .. yes no maybe? I'm currently precepting and I've nasally intubated twice. Both pt's were unresponsive but had a gag reflex, both were in trismus, both had secretions in the posterior pharynx, both were breathing irregularly and poor O2 stats, for me it worked both times. If it hadn't I was going to resort to a nasal airway and bag the pt. I've found that medics either believe in nasal intubation or they don't and I wanted to get a general feeling as to why.

So anyone with experience(s) with nasal intubation care to share? And any tips or ideas that you've found make it more successful or unsuccessful?

Thanks,

-Barefootedkiwi

[HellsBells]

I think that to answer this question properly, it must be established if your service allows RSI. If there is no paralytic in car I'd imagine nasal intubation would be nessasary in some cases.

[Barefootedkiwi]

Our service, and most of the services in PA are not allowed to do RSI.

[scott33]

Our service, and most of the services in PA are not allowed to do RSI.

What benzos do you carry? We occasionally have given Valium as a discretionary order for trismus, given we don't allow nasal intubation.

[Emtgirl101]

Nasel intubation is used when a oral airway isnt possiable due to mouth truma , or if the patient has a gog reflex and wont take the oral airway , you have to becarefull with a nasel you can go in the wrong way it should never be forced in. if it doesnt go in the 2 or 3 time resort to bvm if you have to its better for patient safety in my eyes.

[FL_Medic]

If they had trismus, how do you know about the posterior secretions? Maybe I read that wrong.

Anyhow, nasal intubations sound like a good option in a RSI-less system. I would still provide a benzo, or maybe some pain management for this patient undergoing an uncomfortable procedure.

Just remember, if the patient has an airway, why mess with it? There are, of coarse, some exceptions. A gag reflex is a good thing. If they are ventilating good (good ETCO2), and oxygenating adequatley... maybe they shouldn't be messed with.

Do you cary nasopressin, or something to reduce trauma induced epistaxis?

[FireMedic65]

If they had trismus, how could you know there were secretion, or had gag reflexes? Maybe I read this wrong as well. Anyway, in PA you have a few choices, depending on your region. I would have gotten an order for Ativan, for Versed, maybe Valium to help relax the jaw so you could get a tube in. It would also depend on what was going on with the patients, why were they like this? If you suspected trauma, nasal intubation would be out of the question.

[p3medic]

Noisy upper airway sounds and a patient gagging on their secretions might be a clue, without actually visualizing or physically stimulating a gag yourself.

[Dustdevil]

If you suspected trauma, nasal intubation would be out of the question.

Huh?

[FireMedic65]

Huh?

oops, head trauma. my bad