Initial trauma management in RTC entrapment -

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>> perhaps, in need of ventilation and oxygenation.  Can nasal intubation be
> an
>> acceptable option here?
> 
> my opinion is no... i wouldn't put anything up the nose of a casualty with
> head injury... the picture of the ng tube coiled inside the cranium springs
> to mind...
This is a popular myth not backed by evidence. An NG tube (and a nasal
epistat) are narrow hard tubes that can (very rarely) penetrate the cranium.
A nasopharygeal tube is wide and soft and will not go through a base of
skull fracture. (it is also well tolerated by the patient and unlikely to
make them gag.

In our pre-hsopital system we routinely place two nasopharyngeal airways in
head injured patients to help maximise oxygenation. It is important that we
debunk this myth as nasopharyngeal airways have several advantages over
oro-pharyngeal airways but are little used due to the erroneous fear of
cranial penetration.

There is little need in our pre-hospital system for naso-tracheal intubation
so I cannot really speak from experience. However, in the same way a
naso-tracheal tube is too wide to penetrate the cribriform plate so there
should be little reason to worry. I have seen no reports of cerebral
intubation (!) and head injured patients routinely have nasal intubation in
the intensive care unit.
Tim.
-- 
Mr. T J Coats
Senior Lecturer in Accident, Emergency and Pre-Hospital Care
Bart's and the Royal London School of Medicine

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