AIRWAY MANAGEMENT

NASOTRACHEAL INTUBATION

1. Discuss indications

a. Possible spinal injury

b. Clenched teeth

c. Fx jaw, oral injuries or recent oral surgery

d. Significant angioedema

e. Obesity

f. Arthritis, preventing positioning placement in the sniffing position

2. Discuss conditions where NOT indicated

a. Suspected nasal Fx

b. Suspected basilar skull Fx

c. Significantly deviated nasal septum or other obstruction

d. Cardiac or respiratory arrest

e. Unresponsive patient

3. Discuss advantages of nasotrachael intubaton

a. Head and neck can remain in neutral position

b. Less gag response than ET intubaton

c. More easily securing then orotrachael tube

d. Patient cannot bite the tube

4. Discuss the disadvantages of nasotrachael intubaton

a. More difficult and more time consuming than orotrachael

b. Potentially more traumatic for patients. Passage of tube may lacerate the pharyngeal mucosa or larynx

c. Tube may kink or clog more easily than an orally placed ET

d. Poses greater risk of infection because introduces nasal bacterial into the trachea

e. Improper placement is more likely as direct visualization through glotic passage not possible

f. Requires the patient is breathing

5. Demonstrate the technique

a. Open the airway and ventilate using standard bls

b. Prepare equipment and patient keeping suspected cervical trauma in mind

c. Inspect the nose and select the larger nostril

d. Apply topical anapestic with hurricane spray, lidocaine, neo-synepherine etc

e. Insert ETT into nostril with bevel along the floor of the nostril or facing the nasal septum. Guide the ETT from anterior to posterior

f. As you feel the tube drop into the posterior pharynx listen closely at the proximal end for respiratory sounds.

g. With the patients next inhaled breath advance the ETT gently but quickly into the glotic opening. Continue to pass ETT until the distal cuff is just past the vocal cords. Gagging or vocal sounds are signs of esophageal placement. When placed correctly will see condensation and feel air coming from the proximal end of the ETT

h. Demonstrate techniques for securing tube

Have each student practice the technique