NG Tubes

[Bieber]

So it occurred to me the other day that I've never put down an NG tube, not even on my cardiac arrests that I'd intubated. I always checked to make sure we had them fully stocked on the truck, but I never did use one or even really think about it. What about you? When's the last time you put an NG tube down? Do you drop one on all intubated patients? Does anyone know if it significantly decreases mortality from aspiration in the prehospital setting or has any studies touching on it? Also, do you deliver any medications by NG tube such as activated charcoal for unresponsive non-narcotic OD patients?

It's been a while since I've even read up on NG tubes so that's something I'll need to go back and do today or tomorrow, but I was just wanting to get some feedback from you guys.

[Doczilla]

We drop one on all intubated patients in the ER, but i don't know that it's in the scope of practice for paramedics here. It is potentially useful when the stomach is very distended from BVM ventilations and you're having a hard time getting good volumes after intubation, which would be the only "absolute" indication I could see for doing one in the field.

With regard to charcoal, I hardly ever use it anymore. Not much of a benefit in most cases, too many potential complications. We've really moved away from giving it empirically in poisonings except for certain select agents.

'zilla

[JTpaintball70]

Ive dropped an og tube on one of my trauma patients I intubated, but I'm the only one at my service to do something like that.

[DartmouthDave]

Hello,

Doc's post covered things nicely. But, I would like to add one small thing.

I think inserting an OG is a better option than an NG in an intubated patient for a few reasons. It is easier (even more so if a paralytic was used), no worries of a baslar skull fracture, epitaxis, or a sinus infection tracking down the NG.

Cheers

[queensland paramedic]

inserted one the other day on a 3y/o drowning, worked beautifully, reduced stomach distension and was able to ventilate well, not sure if coincidence but within 2 minutes of the NG Tube and aspiration of stomach had ROSC back.

[Paramagic]

Hello,

Doc's post covered things nicely. But, I would like to add one small thing.

I think inserting an OG is a better option than an NG in an intubated patient for a few reasons. It is easier (even more so if a paralytic was used), no worries of a baslar skull fracture, epitaxis, or a sinus infection tracking down the NG.

Cheers

Yep. Use them routinely, especially in children nice and early, but they are good in adults too, for the reasons Doc posted. I typically go OG as well for trauma patients, will use NG for non-traumatic cases occassionally, but mostly I'm in the habit of going OG.

Never had charcoal.

[celticcare]

Not seen them used in the field here, however dropped them in at work. Not seen it routinely done for intubated patients either. We use charcol here and its not used that much, but still use it time to time. Had a run of three days where I was giving charcol and there are some nurses been there longer than me haven't yet given it. One was for an anti-depressant OD that we caught early enough, *like took the pills, called 111 and then had vomited most of them up so was within 30 mins* and so gave her a big ol cup of charcol to swig back and she did it like a trooper.

I am going to ask about NG though in arrests, and also about OG's as haven't used or seen one of those.

Scotty

[BCEMSmedic87]

We put one in the other night when this drunk chic chewed a bottle of xanax right in front of us...but the crazy thing is hospitals in our area are steering away from gastric pumping and lavage...cause its so messy...that's crazy if you ask me...but they say it ain't killing them...they can just sleep it off...blew my mind!!!

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[Paramagic]

...but the crazy thing is hospitals in our area are steering away from gastric pumping and lavage...cause its so messy...that's crazy if you ask me...but they say it ain't killing them...they can just sleep it off...blew my mind!!!

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[zippyRN]

Not seen them used in the field here, however dropped them in at work. Not seen it routinely done for intubated patients either. We use charcol here and its not used that much, but still use it time to time. Had a run of three days where I was giving charcol and there are some nurses been there longer than me haven't yet given it. One was for an anti-depressant OD that we caught early enough, *like took the pills, called 111 and then had vomited most of them up so was within 30 mins* and so gave her a big ol cup of charcol to swig back and she did it like a trooper.

I am going to ask about NG though in arrests, and also about OG's as haven't used or seen one of those.

Scotty

an NG or OG tube on anyone intubated is great idea esp. if they've been ventilated with pharyngeal or no adjunct - this is one of the things which hacks me off slightly about those Anaesthetists or Resus Officers who oppose supra glottic airways on hospital crash trolleys - it's not instead of the anaesthetist dropping an ET when they are there it's stop the ward staff and/or the medical SHO from distending the patient's belly in the initial stages ...

an NGtube on an a patient with bloated , belly from gas or gastric stasis who is distressed because of it is a good measure, randomly putting NG tubes down any surgical patient is ritualised care and doesn't take account of the damage you can do with an NG tube

We put one in the other night when this drunk chic chewed a bottle of xanax right in front of us...but the crazy thing is hospitals in our area are steering away from gastric pumping and lavage...cause its so messy...that's crazy if you ask me...but they say it ain't killing them...they can just sleep it off...blew my mind!!!

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rarely indicated vs charcoal in recent ingestion and very very risky if performed on the unanaesthetised patient alternatively the issues of anaesthetising the patient and the risks and resource implications that brings ...