Insertion of a nasopharyngeal airway in a patient with head trauma

[AnthonyM83]

Does anyone know the # of reported cases of intracranial placement of an ET tube after nasotracheal intubation?

I wonder how many cases went unreported....

Not that I'm trying to support a possibly dated mentality about the cranial vault thing, BUT we have to also consider that it's a contraindication, so number of NI's with head trauma are already going to be miniscule, especially in prehospital care (I imagine where most NI's occur? since we don't have RSI and such) which has only been around for a short time.

[rat115]

I am not coming at this with any medical evidence... just a question in theory.

How can you evaluate the injuries that were not sustained by refraining from placing an airway?

Being a BLS provider and not having ALS nearby, you're going to have to make a judgment call, as Scotty, Zilla, and chbare pointed out. You did what you could. Watching pt vitals and SAO2 readings is exactly the right thing to do. Sounds like you made the best call for your pt.

Jeepluv, you're taught those things for the extreme cases. You'll learn to use your judgement as you go through clinicals as to when O2 at 3lpm nc is better than 15lpm nrb. It comes with time and training.

[firedoc5]

chbare had one of the best answers. And on the question of having a pt. with severe facial injuries / fx's, a npa may your only way of obtaining a stable airway. The best would be able to intubate, but if you're not an ALS unit then that might be your only action.

I have heard many "horror" stories of these situations, but I've never heard if any of them were absolutely true or not. Mostly it was stated as a "possible" situation.