Nasotracheal Intubation of Apneic Patient

[fab]

Good points, but I am willing to bet that not a single one of these nasal intubations, unless assisted visually in another way, was done on apneic patients, right? There is good reason that we nasally intubate breathing patients only. I've done a half dozen nasal intubations now and it's not easy, it my experience and at my level of skill.

Sorry to disappoint you mate but most had received at least 1mg of Remifentanil (syringe driver obviously still running), 1.5-2mg (per kg) of Propfol, and about .5 (per kg) of Rocuronium (and a lot of oxygen ) ... You can consider them apnoeic. No visual guidance. As I said, I was shocked. It works though. I usually visualized the vocal cords while intubating nasally, simply to get the hang of that. I very rarely had to touch the Magill foreceps, normally the tube slips in easily. I still remember my very first attempt, got the tube in but broke the cuff. That never happened again.

[Spock]

Tearing the cuff with the magills is why we use the glidescope and balloon inflation technique that I mentioned. ERDoc is right that nasal intubations are a lost art. Only paramedics do it because so many places in the U.S. do not allow RSI and they have no other option.

[DwayneEMTP]

Sorry to disappoint you mate but most had received at least 1mg of Remifentanil (syringe driver obviously still running), 1.5-2mg (per kg) of Propfol, and about .5 (per kg) of Rocuronium (and a lot of oxygen ) ... You can consider them apnoeic. No visual guidance. As I said, I was shocked. It works though. I usually visualized the vocal cords while intubating nasally, simply to get the hang of that. I very rarely had to touch the Magill foreceps, normally the tube slips in easily. I still remember my very first attempt, got the tube in but broke the cuff. That never happened again.

What is the relaxed state of the apiglottus? Isn't it closed? And if the resting state is closed, can someone explain to me how we're getting all of these blind tubes down all of these apneic patients through a closed epiglottus (epiglotti (?))without doing any type of damage to the airway?

[fab]

If it was closed, a BVM (or any other supraglottic airway) wouldn't do much good I guess... only once had to wait for inspiration to slip the tube in, that was on the street though (and rather due to the vocal cords being 'closed'). I did some research, interesting question really.

I just tried it with a bottle of water, if you seal the bottle-opening with your lips and swallow while compressing the bottle all you do is blow out your cheeks. Whereas doing the same thing while relaxing you can actually inflate the lung...

Tearing the cuff with the magills is why we use the glidescope and balloon inflation technique that I mentioned. ERDoc is right that nasal intubations are a lost art. Only paramedics do it because so many places in the U.S. do not allow RSI and they have no other option.

Looks interesting too...

[scubanurse]

Holy cow those videos are ridiculous... but very very cool!

[DwayneEMTP]

Grrrr...can't see the vids...Can someone paraphrase?

[Spock]

Blind nasal intubations is truly a lost art. I've done them on unconscious breathing patients that were not chemically paralyzed using an endotrol tube and a whistler in the OR and I always get strange looks from everybody because it is a rare technique.

[mobey]

Dwayne: The first was a awake intubation. Nothing nasal related, just cool too see.

The 2nd was a nasal intubation. He simply slid a cuffed tube down the nare, and it landed right into the trachea.

[DwayneEMTP]

Thanks Mobes...

[HellsBells]

Look, Id say under the circumstances, good job on the nasal intubation. For the sake of argument, lets say that this is a viable code (clenched jaw not from rigor) and you have to transport asystolic pts, then this is probably the best manner in which to transport him. I would imagine cricking him would lead to significant interruptions in cpr and I would rather transport a pt with a definitive airway rather than BVM.

However, it is pretty dumb to have to transport pts in persistent aystole in the first place.