Nasal intubation

[Dustdevil]

Sorry... still not following the logic.

[FireMedic65]

Sorry... still not following the logic.

Possibility of a basilar skull fracture... the tube going right up into the brain... come on, that's like the first thing they taught in EMT-B when using a nasal pharyngeal airway

[scott33]

Possibility of a basilar skull fracture... the tube going right up into the brain... come on, that's like the first thing they taught in EMT-B when using a nasal pharyngeal airway

This practice is highly outdated and based purely upon a couple of instances of it ever happening. You are more likely to die from the latex-induced allergic reaction than have rubber piercing your brain.

It's kind of like doing away with all IV access, due to the possibility of introducing detached catheters into the venous system - such as mentioned elsewhere

The NPA / head trauma contra is just one of the many old practices, which should either be reviewed (ie use cation) or abolished altogether. There are far more examples of potentially dangerous practice which we perform daily without a second thought.

Edited March 17, 2009 by scott33

[CBEMT]

Possibility of a basilar skull fracture... the tube going right up into the brain... come on, that's like the first thing they taught in EMT-B when using a nasal pharyngeal airway

And like so many things they taught in EMT-B, nobody can prove it.

[AnthonyM83]

I would imagine an ET tube to have more force than a floppy NPA.

I've been told it's not really a contraindication for NPA, but that it is for nasal intubation...or at least a relative contraindication... (with a cribiform plate fx an ET could push right in...)

[Dustdevil]

Anyone with the massive injuries it would require to facilitate such a misplacement is dead anyhow. Studies have found no instances of this ever occurring, other than the one that is commonly held up as an example. And the circumstances of that one example remain dubious. This is very, very old news, and outdated practice. Any school still teaching this nonsense as gospel probably sucks.

[AnthonyM83]

As far as breaking through the cribiform plate itself, that takes pretty little effort.

During a cadaver lab, our medical director had us push through it with one of the surgical tools (similar to a screw driver) to demonstrate this. No wind-up was really needed...mainly wrist action (and cadaver was in 40's).

As far as this translating to NT contraindications, doesn't mean too much...other than massive forces from pt's original injury aren't necessarily needed to break through. Of, course that'd be a pretty damn specific injury to have...

[Robbyemtp]

My first field intubation was nasal/oral intubation and was successfully done and confirmed by xray. It was the first and last time ever found it neccessary to do. We don't carry RSI drugs but they are in our protocols. I run a squad and could purchase/carry them but the times we would actually use them are slim to none. Secondly, if it is indicated, we have a helicopter on the way and they carry the drugs. Nasal intubation is contraindicated with skull and facial trauma in our protocols. I have to agree, it does seem outdated but nonetheless, not put my card in jeopardy for a dead patient. BVM with oral airway and get up and go.

Rob

I tried to edit that but something happened. I didn't mean to say oral airway because that is why we are using nasal. BVM with nasal airway is better than nothing. GET'EM moving.

Rob

[AnthonyM83]

I have to agree, it does seem outdated but nonetheless, not put my card in jeopardy for a dead patient.

Would you usually intubate dead patients? Usually a skill used to prevent them from becoming dead . . .

[mobey]

Hmmmm, pic won't show

Oh well, check this out: http://bp3.blogger.com/_oAQI4j4B9Zc/R4JvMi...600-h/ryles.jpg

http://bp0.blogger.com/_oAQI4j4B9Zc/R4JvMy...00-h/ryles3.jpg

Edited March 18, 2009 by mobey