Nasotracheal Intubation (was RE: Thanks Karim)

Tue Mar 6 14:20:04 GMT 2007

Firewall's gotten a little sticky.  Apologies if this arrives twice:

First, my semi-annual reminder to List members: PLEASE use a subject
line that has something remotely to do with the content of your missive.
It's very helpful to folks who receive a hundred or more emails a day,
and more likely to get your message its proper attention.

As for prehospital nasotracheal intubations in trauma: no.  It's
complication-prone and frightfully messy.  

An expert with a bag-valve-mask device can ventilate almost anything for
the time you need.  The problem is convincing intubation-horny
clinicians that being a BVM expert is worth their time and practice.

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Anthony Caruso
Sent: Tuesday, March 06, 2007 12:13 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Thanks Karim

Thanks Tim.
-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Hardcastle, Tim, Dr <tch at sun.ac.za>
Sent: Tuesday, March 06, 2007 12:01 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Thanks Karim

Anthony

Trauma rule no 1: Keep it simple! If you can't tube em easy via the
mouth
and you're not credentialled to do a surgical crico (which would be
standard
of care for paramedics in South Africa), then simple is good manual
airway
control and BVM ventilation. The evidence out there is that these
patients
do better than those who get drugged up and paralysed. In the flight
situation this is difficult and therefore you have to decide if flight
is
better than road. If it is, then your aircrew should have the extended
skills for RSI, this obviously is an issue to be resolved by your state
/
national medical board or whoever controls the scope of practise.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit Division
of
Surgery (General) Room 4064 Department of Surgical Sciences Tygerberg
Hospital / University of Stellenbosch PO Box 19063 Tygerberg 7505
Western
Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Anthony Caruso
Sent: Tuesday, March 06, 2007 6:08 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Thanks Karim

Nasal tube would be for someone that had a clenched jaw.  We do not
carry
any type of paralyzing agent on the rig.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]
On Behalf Of Andrew J Bowman
Sent: Monday, March 05, 2007 10:46 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Thanks Karim

I also avoid NT. Orotracheal intubation can be accomplished in trauma
with
manual in-line stabilization and with the anterior part of the c-collar
removed during the intubation. If glottic visualization is still
difficult
use a bougie catheter.

Andrew

On 3/5/07, Errington Thompson <errington at erringtonthompson.com> wrote:
>
> Nasal intubations should be avoided.  If you are able to bag the
> patient I would rather have a patient that is bagged than a tube in 
> the nose.
>
> I would add I hating Combitubes.
>
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Surgical Critical Care
> Mission Hospital
> Asheville, NC
> Author - A Letter to America
> www.whereistheoutrage.net
>
>
> Everyone deserves to make an informed decision
> - Errington Thompson, MD
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Anthony Caruso
> Sent: Monday, March 05, 2007 9:12 PM
> To: trauma-list at trauma.org
> Subject: Thanks Karim
>
> Evening all. I would like to ask the group there opinion on how they
> feel about nasal intubations pre-hospital in the trauma setting?  In 
> my region, in Massachusetts we are about 22 min away from a level 1 
> trauma center at almost any given time.  On board, we do carry 
> Hurricane spray along with affrin to vasoconstrict the nares.  Usually

> a 6.0 ID or a 6.5 would do the job with a little more air in the cuff 
> than normally used.  (About 12m/L of
> air) and liberal use of lidocane jelly.
>    I'm particularly interested in closed or open head trauma.  However

> if you have any type input on this subject then I would certainly 
> welcome it. Also Dr. Gross, I believe that you flew, or still work on 
> a medical rescue helicopter.  What was your experience when you 
> encountered someone that was nasotracheal intubated?
>     Sincearly,
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