Idea for nasal intubation

[tchristifulli]

 

[tchristifulli]

Tried this on a unresponsive patient who had his teeth clenched. Spo2 was 78%. Our protocols say we need 2 medics to RSI. I was running with a tech that day. Used a 5.0 tube and this trick worked perfect.

 

[chaz90]

I'm a bit unclear as to what exactly you did...

 

[DesertMedic66]

I'm a bit unclear as to what exactly you did...

I'm assuming he/she connected the end of their steth to the tube and used it to intubate. The steth allowed them to hear air pass by to make sure they were in the right tube.

 

[tchristifulli]

Exactly

 

[tchristifulli]

We don't have the BAAM device where I work so you can't hear the whistle

 

[DesertMedic66]

I've heard about it being done during my EMT class but that's about it. I'm only an EMT so it's not in my scope and we don't have nasal intubation in our medic protocols either.

 

[Clipper1]

Tried this on a unresponsive patient who had his teeth clenched. Spo2 was 78%. Our protocols say we need 2 medics to RSI. I was running with a tech that day. Used a 5.0 tube and this trick worked perfect.

Was this for a pediatric patient? A 5.0 tube is only about 24 cm in length which means if used nasally on an adult it is only a supraglottic device and would need to be changed quickly. There is also a risk of damage to the cords with an inappropriate sized device. Even a 6.0 might come up very short on an adult if done the nasal route. Usually these get secured at about 26 - 28 cm at the nare.

 

[tchristifulli]

No just a small adult

 

[Clipper1]

Even small adults like a 4'11" Asian female would be taped at 20 - 21 cm oral. The cuff is 2 - 3 cm in length at 1.5 cm above distal tip. If this was a male, at least a 6 or 6.5 should be considered even nasally. At least then the patient might last on a ventilator for a little while before changing the tube.

 

[NomadicMedic]

I was always told the average tube size for adult nasal intubation is a 6.5. We carry enditrol tubes and BAAM whistles, but they never get used.

 

[tchristifulli]

Yah I agree it was probably on the small side. I appreciate the advice though. It seemed to work just fine and the doc left it in for awhile. I'm sure a 6.5 would be about right. Just seems real big to be putting in this dudes nose lol.

 

[Clipper1]

The diameter is definitely small and will affect wob. But the length is of most concern. It would be sad to have a good idea for facilitating NTI ruined by the pt's death due to aspiration from the cuff being mal positioned.

 

[tchristifulli]

I think that's a little extreme. I didn't kill the guy man.

 

[VFlutter]

I think that's a little extreme. I didn't kill the guy man.

Nope, but you didn't really secure the airway either. Aspiration is a serious and real concern.

 

[Trashtruck]

I think it's a cool idea.
If I didn't have a BAAM and had a p.o.s. stethoscope, I'd do it.

 

[NomadicMedic]

The OP never said anything about not fully securing the airway. He only said that he nasally intubated a patient. Clipper was the one who insinuated that he may not have fully secured the airway due to the length of the tube, which is mere speculation on her part.

 

[Clipper1]

Speculation? No. Any decent intubation class should teach you to be mindful about tube length and anatomical placement. Securing an airway coorectly is important. Look it up if you don't believe me about the length of the tube and the placement of the cuff. Don't let your attitude get in the way of possibly learning something about tubes. You may not realize that some who work in hospitals measure the tube length for a few different reasons. The complications from poorly positioned tube can quickly undo all good efforts.

 

[NomadicMedic]

Speculation? No. Any decent intubation class should teach you to be mindful about tube length and anatomical placement. Securing an airway coorectly is important. Look it up if you don't believe me about the length of the tube and the placement of the cuff. Don't let your attitude get in the way of possibly learning something about tubes. You may not realize that some who work in hospitals measure the tube length for a few different reasons. The complications from poorly positioned tube can quickly undo all good efforts.

...and again, the OP simply related that he nasally intubated a patient. There was no mention of the tube not passing the glottis. YOU were the one who SPECULATED that the tube was placed incorrectly. (And I'll define it because you seem to have trouble understanding what I'm writing. Speculation: to form a theory or conjecture about a subject without firm evidence.)

See what I did there? I called you out for being a doomsayer.

I appreciate your passion for the subject, but don't let YOUR attitude, or your thinly veiled distaste for EMS providers get in the way of the message. Not every paramedic is a ham-fisted imbecile.

 

[Tigger]

Not to play the whole "better than nothing card," but my partner nasally intubated a patient a few weeks ago with a 6.0 tube and she was a fairly large lady. She also had very small nostrils (we could only get a 18 or 20fr NPA I can't remember). The NPA wasn't cutting it and the 6.0 was as big as would fit. So would you rather see a patient with an unprotected airway being single person BVMed or a possibly supraglottic airway in place?