Nasal intubations

[Capt68]

Just curious how many medics out there do nasal intubations (by choice) or if you would rather try to knock them down and do it orally.

Personally, I would rather knock them out. I have seen many a good medic try and try and try again to get a nasal tube on a patient that needs the tube. Plus do you see the pain the patient is going through getting a 7.0 tube (which is to small anyways if they need the tube) crammed down their nose, in my eyes your doing more harm than good. Ryan

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62 Engine 67 Truck ... The Pride of the West Side

[ME93]

I also prefer to knock the patient out before trying to establish an advanced airway. It has less stress on the patient and yourself. I have had the oportunity in the past to do all nasal tubes before paralytics and sedatives became available. I would take the oral route with knockin' them out any day.

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Fishers Fire Dept.
FF/Medic
Local 416

[Litch]

The oral route clearly has advantages over nasal intubation. However, not all systems are blessed with paralytics to be able to snow the patient and orally intubate. Endotrol tubes and BAAM's make nasal intubations much easier for both the medic and the patient.

[MaryAnn329]

We have the option of doing either, and decide based on the situation and the patient. Many of the meds used for RSI impact the patient hemodynamically, so an already hypotensive patient may not tolerate the RSI and nasal is a better route.

Nasal intubation does not have to be traumatic for the patient. Most of us just don't use the skill enough to be comfortable with it. I have seen (and done) nasal intubations when the only reaction from the patient was a cough.

Oral intubations are more comfortable for most of us - we don't like to do anything blind. But in some cicumstances, nasal intubation works great.

[chief4102]

I agree with MaryAnn. We need to be able to use both comfortably. Situations arise where nasal is a better choice, and where sedation will be better for the patient. Nasal intubations do not have to cause trauma to the patient if properly done. At least that is my opinion and observation.
Be Safe
Dan

[Paramark14]

We carry Norcuron and have the option. I prefer oral: 1) less trauma to the pt. 2)I can visualize the cords and I know when I'm in. The only nasal I've ever done was during medic school clinicals. I had an elderly female in severe distress (CHF). We tried nebs, lasix, MS, you name it and she just kept getting worse. My preceptor had me try a nasal and by the grace of God I got it (beginners luck). She seemed to accept it pretty well. By the time we got to ER her lung sounds were better and her SaO2 was 96% (on scene 70%). They put her on PEEP and she had a great outcome. I feel that she was already compromised and in that situation the nasal was the way to go initially. If I would'nt have got it we most likely would have tried sedation. As I said, I prefer the oral ET but nasal intubation is something that should still be taught and practiced.

Mark
NREMTP
Indiana

[ALSfirefighter]

I also agree with MaryAnn and Chief4102, while I also would prefer to orally intubate 100% of the time, I think that nasal intubations still have our place. In fact I think that it is a skill that gets overlooked in the face of a patient who needs to be intubated, but for whatever reason narcs are not an option. Or as some of us have seen, they have the tolerance to narcs like a large animal. I have even had a couple instances where I looked back after the call and realized I should have attempted the nasal route. And in my experience I have seen patients tolerate a nasal tube a lot better then one with a gag reflex snowed. Hopefully in the not too distant future we will not only have an RSI protocol that a couple of agencies in my region have been testing, but they will be expanded from what parameters they are being used in. I have had a few asthmatics that I could've tubed a lot sooner if I had some Suc's, to go with the MS and then Valium I gave (I have never liked using Versed).

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http://www.firehouse.com/forums/biggrin.gif..The above is my opinion only and does not relfect that of any dept./agency I work for, deal with, or am a member of.