🚀 go-pugleaf

Lamont Cranston wrote:
> 
> do you use nasotracheal intubations in your system? in the system I am
> familiar with they have very high success rate with them, even in closed
> head and facial trauma. I know everyone has seen or heard of the
> intubated cranium, but do you know that it is the only case of this
> happening ever?


We do a fair number of blind nasal intubations. It is a relatively easy form of 
intubation (in my experience) and is a good choice for certain patients, 
including the head injured. I have only had one instance (knock on wood) where I 
could not nasally intubate someone and went the oral route.

Some of the advantages are in the head injured pt:
*no need to manipulated the neck (as one would with laryngoscopy...even with the 
head in neutral alignment)
*not affected by trismus
*if the pt is sitting on the slippery slope of the GCS and has an intact gag 
reflex, the nasal ETT is better tolerated because it sits against the posterior 
wall of the hypopharynx and tends not to stimulate the gag as much as an oral ETT
*in the patient who initially presents comatosed and improves neurologically 
after hyperventilation, it is better tolerated for the reason just metioned. In 
addition, the patient can't bite down on or chew on the tube. Less sedation may 
be required (personal judgement call)
*can be performed on most head injuries, with the exception of the severe facial 
smash. There are no ABSOLUTE contraindications. It's not like passing an NG tube. 
With the nasal ETT you are constantly listening for air movement through the 
tube. Obviouly, oral intubation would be the route of choice in a facial smash.

* also works well in the awake intubation (with some sedation):  

eg. the patient in imminent or actual respiratory failure (my choice, if it were 
available to me however would be RSI)

Cheers

Rob Theriault  EMCA, RCT (Adv.), EMA III
               Critical Care Flight Paramedic
Bandage 1
Toronto, Ontario
Canada