Airway Question

[Guest guest]

Ok group,

I normally do more reading than talking on here, but I have a question that is

killing my brain, LoL. I'm studying for my NREMTP using the " Caroline's

Emergency Care in the Streets 6th Edition "  student workbook.

Under the " Airway Management & Ventilation " chapter the question states,

You have a 42 y/o female extricated from a wrecked vehicle; she is unconscious

and has a depressed skull fracture at the back of her head. To secure an airway

would you choose,

A. Blind nasotracheal intubation as the preferred technique.

B. Tracheal intubation as the preferred technique.

C. Cricothyrotomy as the preferred technique.

I chose " B' as my answer, and was told (by the answers in the back of the

book) that the correct answer was " A " . Please correct me if I'm wrong as I am

still learning, but have we not always been taught NOT to use nasotracheal

intubation if the pt has a skull fracture of any kind?

Everyones input will be greatly appreciated, because I really need to pass my

test.

Thanks,     

 R.

Democracy will cease to exist when you take away from those who are willing to

work and give to those who are not.

Jefferson

[Guest guest]

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

toni_crippen@... writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Guest guest]

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

toni_crippen@... writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Guest guest]

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

toni_crippen@... writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Guest guest]

actually, the BAAM 'whistle' is one of them- I learned NT intubation well

before that was introduced, and having one's ear near an open tube when the

patient coughs a big lugie out is NOT a pleasant experience.

The other item is a good pair of Magill forceps... and maybe a Grandview

blade...

ck

In a message dated 5/6/2010 17:43:37 Central Daylight Time,

toni_crippen@... writes:

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

[mailto:_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ] On

Behalf Of _krin135@..._ (mailto:krin135@...)

Sent: Thursday, May 06, 2010 5:27 PM

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

_toni_crippen@toni_crippeton_ (mailto:toni_crippen@...)

writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

actually, the BAAM 'whistle' is one of them- I learned NT intubation well

before that was introduced, and having one's ear near an open tube when the

patient coughs a big lugie out is NOT a pleasant experience.

The other item is a good pair of Magill forceps... and maybe a Grandview

blade...

ck

In a message dated 5/6/2010 17:43:37 Central Daylight Time,

toni_crippen@... writes:

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

[mailto:_texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ] On

Behalf Of _krin135@..._ (mailto:krin135@...)

Sent: Thursday, May 06, 2010 5:27 PM

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

_toni_crippen@toni_crippeton_ (mailto:toni_crippen@...)

writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

of course, the 'trigger' type tubes (where there is a way to flex the tip

of the tube, and the bevel is always at the outside of the curve) can also

help blindly intubating a patient without obvious respirations.

(nothing like hitting 'send' before completing the thought.)

ck

In a message dated 5/6/2010 17:52:31 Central Daylight Time, krin135@...

writes:

actually, the BAAM 'whistle' is one of them- I learned NT intubation well

before that was introduced, and having one's ear near an open tube when

the

patient coughs a big lugie out is NOT a pleasant experience.

The other item is a good pair of Magill forceps... and maybe a Grandview

blade...

ck

In a message dated 5/6/2010 17:43:37 Central Daylight Time,

_toni_crippen@toni_crippeton_ (mailto:toni_crippen@...) writes:

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: _texasems-l@From: _texasems-l@ ya_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) )

[mailto:_texasems-[mailto:_texasem[mailto:_te_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) ) ] On

Behalf Of __krin135 (AT) aol (DOT) _kr_ (mailto:_krin135@...) _

(mailto:_krin135@..._ (mailto:krin135@...) )

Sent: Thursday, May 06, 2010 5:27 PM

To: _texasems-l@To: _texasems-l@ yaho_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) )

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

_toni_crippen@_toni_crippen@ toni__toni_crippen@toni_crippeton_

(mailto:toni_crippen@...) )

writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

of course, the 'trigger' type tubes (where there is a way to flex the tip

of the tube, and the bevel is always at the outside of the curve) can also

help blindly intubating a patient without obvious respirations.

(nothing like hitting 'send' before completing the thought.)

ck

In a message dated 5/6/2010 17:52:31 Central Daylight Time, krin135@...

writes:

actually, the BAAM 'whistle' is one of them- I learned NT intubation well

before that was introduced, and having one's ear near an open tube when

the

patient coughs a big lugie out is NOT a pleasant experience.

The other item is a good pair of Magill forceps... and maybe a Grandview

blade...

ck

In a message dated 5/6/2010 17:43:37 Central Daylight Time,

_toni_crippen@toni_crippeton_ (mailto:toni_crippen@...) writes:

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: _texasems-l@From: _texasems-l@ ya_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) )

[mailto:_texasems-[mailto:_texasem[mailto:_te_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) ) ] On

Behalf Of __krin135 (AT) aol (DOT) _kr_ (mailto:_krin135@...) _

(mailto:_krin135@..._ (mailto:krin135@...) )

Sent: Thursday, May 06, 2010 5:27 PM

To: _texasems-l@To: _texasems-l@ yaho_texasems-l@yahoogrotexasem_

(mailto:texasems-l ) )

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

_toni_crippen@_toni_crippen@ toni__toni_crippen@toni_crippeton_

(mailto:toni_crippen@...) )

writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

Having recently graduated, I was taught facial fractures and apnea were the

contraindications for nasal intubations.

Toni

Re: Re: Airway Question

So you're older are Ya bragging or complaining.

Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20

years old it was new to us

Also I think it was Brady or maybe a pre-Brady Publisher that in the same

year as that did a Basic book with a set of color plates that were piloted

in some places in NJ same time. we got a look at that and were all a gast at

the color, it was so novel. Again new to NJ in 1981.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time,

krin135@... writes:

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

_lnmolino@..._ (mailto:lnmolino@...) writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/FF/N

Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance

__LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._

(mailto:LNMolino@...) )

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

__medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _

(mailto:_medic0946@..._ (mailto:medic0946@...) ) writes:

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

>

[Guest guest]

ck,

Since I'm also a respiratory therapist, I'll let someone else get the extra

credit. Lol

-

Sent via BlackBerry by AT&T

Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

toni_crippen@... writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Guest guest]

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: texasems-l [mailto:texasems-l ] On

Behalf Of krin135@...

Sent: Thursday, May 06, 2010 5:27 PM

To: texasems-l

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

toni_crippen@... writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Guest guest]

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: texasems-l [mailto:texasems-l ] On

Behalf Of krin135@...

Sent: Thursday, May 06, 2010 5:27 PM

To: texasems-l

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

toni_crippen@... writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Guest guest]

Well, if the patient isn't breathing, it's rather hard to do blind

nasotracheal intubation.

Back in the days before RSI, I had an apneic patient in trismus that I

nasally intubated.

I had a partner do chest compressions to force enough air out to guide

placement of the tube. It was either that, or do a surgical cric.

The next week, we had an RSI protocol at that service. That incident is

what led to my proposal to the Louisiana EMS Certification Commission

that got RSI added to the Louisiana paramedic scope of practice.

krin135@... wrote:

>

> for extra credit, *why* is apnea a relative contraindication to nasal

> intubation and how can you work around it if you need to?

>

> Hint: there are two pieces of equipment that might make it possible....

>

> ck

>

>

> In a message dated 5/6/2010 17:13:49 Central Daylight Time,

> toni_crippen@... writes:

>

> Having recently graduated, I was taught facial fractures and apnea were

> the

> contraindications for nasal intubations.

>

> Toni

>

>

[Guest guest]

Well, if the patient isn't breathing, it's rather hard to do blind

nasotracheal intubation.

Back in the days before RSI, I had an apneic patient in trismus that I

nasally intubated.

I had a partner do chest compressions to force enough air out to guide

placement of the tube. It was either that, or do a surgical cric.

The next week, we had an RSI protocol at that service. That incident is

what led to my proposal to the Louisiana EMS Certification Commission

that got RSI added to the Louisiana paramedic scope of practice.

krin135@... wrote:

>

> for extra credit, *why* is apnea a relative contraindication to nasal

> intubation and how can you work around it if you need to?

>

> Hint: there are two pieces of equipment that might make it possible....

>

> ck

>

>

> In a message dated 5/6/2010 17:13:49 Central Daylight Time,

> toni_crippen@... writes:

>

> Having recently graduated, I was taught facial fractures and apnea were

> the

> contraindications for nasal intubations.

>

> Toni

>

>

[Guest guest]

Well, if the patient isn't breathing, it's rather hard to do blind

nasotracheal intubation.

Back in the days before RSI, I had an apneic patient in trismus that I

nasally intubated.

I had a partner do chest compressions to force enough air out to guide

placement of the tube. It was either that, or do a surgical cric.

The next week, we had an RSI protocol at that service. That incident is

what led to my proposal to the Louisiana EMS Certification Commission

that got RSI added to the Louisiana paramedic scope of practice.

krin135@... wrote:

>

> for extra credit, *why* is apnea a relative contraindication to nasal

> intubation and how can you work around it if you need to?

>

> Hint: there are two pieces of equipment that might make it possible....

>

> ck

>

>

> In a message dated 5/6/2010 17:13:49 Central Daylight Time,

> toni_crippen@... writes:

>

> Having recently graduated, I was taught facial fractures and apnea were

> the

> contraindications for nasal intubations.

>

> Toni

>

>

[Guest guest]

agreed. at the conference last some doc from jpsh (ft. worth) said that

" intracranial tube migration " was a myth....

jim davis

paramedic

Subject: RE: Re: Airway Question

To: texasems-l

Date: Thursday, May 6, 2010, 5:06 PM

My understanding is that nasal intubation in head injuries has become a general

consensus " moot point " as there have been no documented cases of nasally

intubating the brain in these situations.  Has there been some documented

evidence that it actually DOES and HAS happened that I missed in the last few

years?  If so, someone please share it with us.

Jane Dinsmore

To: texasems-l

From: lnmolino@...

Date: Thu, 6 May 2010 17:31:30 -0400

Subject: Re: Re: Airway Question

 

So you're older are Ya bragging or complaining.

Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20

years old it was new to us

Also I think it was Brady or maybe a pre-Brady Publisher that in the same

year as that did a Basic book with a set of color plates that were piloted

in some places in NJ same time. we got a look at that and were all a gast at

the color, it was so novel. Again new to NJ in 1981.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time,

krin135@... writes:

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

_lnmolino@..._ (mailto:lnmolino@...) writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/FF/N

Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance

__LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._

(mailto:LNMolino@...) )

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

__medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _

(mailto:_medic0946@..._ (mailto:medic0946@...) ) writes:

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

>

[Guest guest]

agreed. at the conference last some doc from jpsh (ft. worth) said that

" intracranial tube migration " was a myth....

jim davis

paramedic

Subject: RE: Re: Airway Question

To: texasems-l

Date: Thursday, May 6, 2010, 5:06 PM

My understanding is that nasal intubation in head injuries has become a general

consensus " moot point " as there have been no documented cases of nasally

intubating the brain in these situations.  Has there been some documented

evidence that it actually DOES and HAS happened that I missed in the last few

years?  If so, someone please share it with us.

Jane Dinsmore

To: texasems-l

From: lnmolino@...

Date: Thu, 6 May 2010 17:31:30 -0400

Subject: Re: Re: Airway Question

 

So you're older are Ya bragging or complaining.

Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20

years old it was new to us

Also I think it was Brady or maybe a pre-Brady Publisher that in the same

year as that did a Basic book with a set of color plates that were piloted

in some places in NJ same time. we got a look at that and were all a gast at

the color, it was so novel. Again new to NJ in 1981.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time,

krin135@... writes:

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

_lnmolino@..._ (mailto:lnmolino@...) writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/FF/N

Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance

__LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._

(mailto:LNMolino@...) )

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

__medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _

(mailto:_medic0946@..._ (mailto:medic0946@...) ) writes:

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

>

[Guest guest]

back in the day we'd pull the head off a cheap stethoscope and stick the tubing

down the ETT (only works with bigger tubes)

jim davis

paramedic

Subject: Re: Re: Airway Question

To: texasems-l

Date: Thursday, May 6, 2010, 5:54 PM

 

of course, the 'trigger' type tubes (where there is a way to flex the tip

of the tube, and the bevel is always at the outside of the curve) can also

help blindly intubating a patient without obvious respirations.

(nothing like hitting 'send' before completing the thought.)

ck

In a message dated 5/6/2010 17:52:31 Central Daylight Time, krin135 (AT) aol (DOT) com

writes:

actually, the BAAM 'whistle' is one of them- I learned NT intubation well

before that was introduced, and having one's ear near an open tube when

the

patient coughs a big lugie out is NOT a pleasant experience.

The other item is a good pair of Magill forceps... and maybe a Grandview

blade...

ck

In a message dated 5/6/2010 17:43:37 Central Daylight Time,

_toni_crippen@ toni_crippeton_ (mailto:toni_crippen@ suddenlink. net) writes:

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: _texasems-l@ From: _texasems-l@ ya_texasems -l@yahoogrotexas em_

(mailto:texasems-l@yahoogro ups.com) )

[mailto:_texasems- [mailto:_ texasem[mailto: _te_texasems- l@yahoogrotexase m_

(mailto:texasems-l@yahoogro ups.com) ) ] On

Behalf Of __krin135 (AT) aol (DOT) _kr_ (mailto:_krin135 (AT) aol (DOT) kri) _

(mailto:_krin135 (AT) aol (DOT) kri_ (mailto:krin135 (AT) aol (DOT) com) )

Sent: Thursday, May 06, 2010 5:27 PM

To: _texasems-l@ To: _texasems-l@ yaho_ texasems- l@yahoogrotexase m_

(mailto:texasems-l@yahoogro ups.com) )

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

_toni_crippen@ _toni_crippen@ toni_ _toni_crippen@ toni_crippeton_

(mailto:toni_crippen@ suddenlink. net) )

writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

back in the day we'd pull the head off a cheap stethoscope and stick the tubing

down the ETT (only works with bigger tubes)

jim davis

paramedic

Subject: Re: Re: Airway Question

To: texasems-l

Date: Thursday, May 6, 2010, 5:54 PM

 

of course, the 'trigger' type tubes (where there is a way to flex the tip

of the tube, and the bevel is always at the outside of the curve) can also

help blindly intubating a patient without obvious respirations.

(nothing like hitting 'send' before completing the thought.)

ck

In a message dated 5/6/2010 17:52:31 Central Daylight Time, krin135 (AT) aol (DOT) com

writes:

actually, the BAAM 'whistle' is one of them- I learned NT intubation well

before that was introduced, and having one's ear near an open tube when

the

patient coughs a big lugie out is NOT a pleasant experience.

The other item is a good pair of Magill forceps... and maybe a Grandview

blade...

ck

In a message dated 5/6/2010 17:43:37 Central Daylight Time,

_toni_crippen@ toni_crippeton_ (mailto:toni_crippen@ suddenlink. net) writes:

LOL - because you need to hear the whistle from the BAAM.

Two work-arounds? A chest compression? cric pressure? Do tell!

From: _texasems-l@ From: _texasems-l@ ya_texasems -l@yahoogrotexas em_

(mailto:texasems-l@yahoogro ups.com) )

[mailto:_texasems- [mailto:_ texasem[mailto: _te_texasems- l@yahoogrotexase m_

(mailto:texasems-l@yahoogro ups.com) ) ] On

Behalf Of __krin135 (AT) aol (DOT) _kr_ (mailto:_krin135 (AT) aol (DOT) kri) _

(mailto:_krin135 (AT) aol (DOT) kri_ (mailto:krin135 (AT) aol (DOT) com) )

Sent: Thursday, May 06, 2010 5:27 PM

To: _texasems-l@ To: _texasems-l@ yaho_ texasems- l@yahoogrotexase m_

(mailto:texasems-l@yahoogro ups.com) )

Subject: Re: Re: Airway Question

for extra credit, *why* is apnea a relative contraindication to nasal

intubation and how can you work around it if you need to?

Hint: there are two pieces of equipment that might make it possible....

ck

In a message dated 5/6/2010 17:13:49 Central Daylight Time,

_toni_crippen@ _toni_crippen@ toni_ _toni_crippen@ toni_crippeton_

(mailto:toni_crippen@ suddenlink. net) )

writes:

Having recently graduated, I was taught facial fractures and apnea were

the

contraindications for nasal intubations.

Toni

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

Unfortunately, we have continued to teach myth as fact over and over again until

it even ends up in textbooks as fact. And since we are such a young profession

with so little research to justify or negate so much of what we have set as

standard of care.

Jane Dinsmore

To: texasems-l

From: james_dav_bmcg@...

Date: Thu, 6 May 2010 16:40:35 -0700

Subject: RE: Re: Airway Question

agreed. at the conference last some doc from jpsh (ft. worth) said that

" intracranial tube migration " was a myth....

jim davis

paramedic

Subject: RE: Re: Airway Question

To: texasems-l

Date: Thursday, May 6, 2010, 5:06 PM

My understanding is that nasal intubation in head injuries has become a general

consensus " moot point " as there have been no documented cases of nasally

intubating the brain in these situations. Has there been some documented

evidence that it actually DOES and HAS happened that I missed in the last few

years? If so, someone please share it with us.

Jane Dinsmore

To: texasems-l

From: lnmolino@...

Date: Thu, 6 May 2010 17:31:30 -0400

Subject: Re: Re: Airway Question

So you're older are Ya bragging or complaining.

Brand new as in NJ went to the 2nd Ed in mid 1981 so it could have been 20

years old it was new to us

Also I think it was Brady or maybe a pre-Brady Publisher that in the same

year as that did a Basic book with a set of color plates that were piloted

in some places in NJ same time. we got a look at that and were all a gast at

the color, it was so novel. Again new to NJ in 1981.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 4:09:26 P.M. Central Daylight Time,

krin135@... writes:

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

_lnmolino@..._ (mailto:lnmolino@...) writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/FF/N

Freelance Consultant/Trainer/Freelance Consultant/Trainer/ Freelance

__LNMolino (AT) aol (DOT) _LN_ (mailto:_LNMolino@...) _ (mailto:_LNMolino@..._

(mailto:LNMolino@...) )

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

__medic0946 (AT) yahoo (DOT) _me_ (mailto:_medic0946@...) _

(mailto:_medic0946@..._ (mailto:medic0946@...) ) writes:

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

>

[Guest guest]

oh? *ANY* head injuries?

Can you describe the difference between the various LeFort fractures?

(hint: this is a *clinical* finding that should only be confirmed by

radiograph) Can you explain why a LeFort fracture might be a reason to consider

a

surgical airway?

Is there any reason not to nasally intubate a patient with an isolated

closed head injury, a GCS of 6, significant trismus, and NO nasal or ear

drainage?

can you give a medical reference for not intubating nasally (and I don't

mean a 'merit badge course' or even one of Dr. Bledsoe's excellent books

Paramedic course books, but a 'real' medical reference?

ck

In a message dated 5/7/2010 02:46:50 Central Daylight Time,

keltongriffin@... writes:

You should never perform nasal intubation with any head injuries it is

contraidicated especially with suspected skull fractures.

________________________________

From: " _krin135@..._ (mailto:krin135@...) " _krin135@..._

(mailto:krin135@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, May 6, 2010 4:09:07 PM

Subject: Re: Re: Airway Question

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

lnmolino (AT) aol (DOT) com writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/ FF/N

Freelance Consultant/Trainer/ Freelance CoFreelance Consultant/Trainer

_LNMolino (AT) aol (DOT) LNM_ (mailto:LNMolino@_LNMolino@

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

_medic0946 (AT) yahoo (DOT) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

> [Non-text portions of this message have been removed]

>

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

oh? *ANY* head injuries?

Can you describe the difference between the various LeFort fractures?

(hint: this is a *clinical* finding that should only be confirmed by

radiograph) Can you explain why a LeFort fracture might be a reason to consider

a

surgical airway?

Is there any reason not to nasally intubate a patient with an isolated

closed head injury, a GCS of 6, significant trismus, and NO nasal or ear

drainage?

can you give a medical reference for not intubating nasally (and I don't

mean a 'merit badge course' or even one of Dr. Bledsoe's excellent books

Paramedic course books, but a 'real' medical reference?

ck

In a message dated 5/7/2010 02:46:50 Central Daylight Time,

keltongriffin@... writes:

You should never perform nasal intubation with any head injuries it is

contraidicated especially with suspected skull fractures.

________________________________

From: " _krin135@..._ (mailto:krin135@...) " _krin135@..._

(mailto:krin135@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, May 6, 2010 4:09:07 PM

Subject: Re: Re: Airway Question

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

lnmolino (AT) aol (DOT) com writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/ FF/N

Freelance Consultant/Trainer/ Freelance CoFreelance Consultant/Trainer

_LNMolino (AT) aol (DOT) LNM_ (mailto:LNMolino@_LNMolino@

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

_medic0946 (AT) yahoo (DOT) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

> [Non-text portions of this message have been removed]

>

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

oh? *ANY* head injuries?

Can you describe the difference between the various LeFort fractures?

(hint: this is a *clinical* finding that should only be confirmed by

radiograph) Can you explain why a LeFort fracture might be a reason to consider

a

surgical airway?

Is there any reason not to nasally intubate a patient with an isolated

closed head injury, a GCS of 6, significant trismus, and NO nasal or ear

drainage?

can you give a medical reference for not intubating nasally (and I don't

mean a 'merit badge course' or even one of Dr. Bledsoe's excellent books

Paramedic course books, but a 'real' medical reference?

ck

In a message dated 5/7/2010 02:46:50 Central Daylight Time,

keltongriffin@... writes:

You should never perform nasal intubation with any head injuries it is

contraidicated especially with suspected skull fractures.

________________________________

From: " _krin135@..._ (mailto:krin135@...) " _krin135@..._

(mailto:krin135@...) >

To: _texasems-l@yahoogrotexasem_ (mailto:texasems-l )

Sent: Thu, May 6, 2010 4:09:07 PM

Subject: Re: Re: Airway Question

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and,

IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

lnmolino (AT) aol (DOT) com writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/ FF/N

Freelance Consultant/Trainer/ Freelance CoFreelance Consultant/Trainer

_LNMolino (AT) aol (DOT) LNM_ (mailto:LNMolino@_LNMolino@

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

_medic0946 (AT) yahoo (DOT) med_ (mailto:medic0946@_medic0946 (AT) yahoo (DOT) m

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

> [Non-text portions of this message have been removed]

>

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

[Guest guest]

Point of order! I believe he was talking about Emergency Care in the Streets,

6th edition, which was published in 2008.

Now, all this is nonsense, since the question is unanswerable. As several have

said, the traditional thinking has been not to insert anything in the nose,

neither an ET tube or a NG tube, if the patient might have a basilar skull

fracture. This myth apparently developed from ONE x-ray that got published in a

few places about 30 years ago. Nobody has ever been able to produce another one

that I know of. If you know of such a case please let us all know.

In fact, the chances of a cranial intubation from a skill fracture are remote

indeed. Yet this particular bit of mythology hangs on.

The " hook " in the Caroline question is that the fictional patient has a

" depressed skull fracture at the back of her head. " That's on the opposite side

of the head from one of the sinuses, which are the alleged site of the phantom

ET/NG tube cranial intubation.

The truth is, however, that without x-rays and CTs it is impossible to know

about all possible fractures to the cranium.

Therefore, the safe answer would be to insert a supraglottic airway, which is

what anybody capable of rational thinking and a rudimentary understanding of

airway care would do under the circumstances.

Beware of workbook questions in ANY workbook that goes with a text. I haven't

found ONE that didn't have quite a significant number of questionablely

formulated items. When something doesn't look right to you, seek further

insight.

And remember that the NREMT-P exam is not rational in any way. It's a " gotcha! "

exam that bears little or no relationship to real paramedic practice, regardless

of its boasts about task surveys and so forth.

Thank you for affording me this opportunity to make you quake in terror! Get

Rahm's book and study it, review the National Standard Curriculum, and

you'll do fine.

Best,

Gene

Re: Re: Airway Question

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

lnmolino@... writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/FF/N

Freelance Consultant/Trainer/Freelance CoFreelance Consultant/Trainer

_LNMolino@..._ (mailto:LNMolino@...)

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

_medic0946@..._ (mailto:medic0946@...) writes:

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

> [Non-text portions of this message have been removed]

>

[Non-text portions of this message have been removed]

[Guest guest]

Point of order! I believe he was talking about Emergency Care in the Streets,

6th edition, which was published in 2008.

Now, all this is nonsense, since the question is unanswerable. As several have

said, the traditional thinking has been not to insert anything in the nose,

neither an ET tube or a NG tube, if the patient might have a basilar skull

fracture. This myth apparently developed from ONE x-ray that got published in a

few places about 30 years ago. Nobody has ever been able to produce another one

that I know of. If you know of such a case please let us all know.

In fact, the chances of a cranial intubation from a skill fracture are remote

indeed. Yet this particular bit of mythology hangs on.

The " hook " in the Caroline question is that the fictional patient has a

" depressed skull fracture at the back of her head. " That's on the opposite side

of the head from one of the sinuses, which are the alleged site of the phantom

ET/NG tube cranial intubation.

The truth is, however, that without x-rays and CTs it is impossible to know

about all possible fractures to the cranium.

Therefore, the safe answer would be to insert a supraglottic airway, which is

what anybody capable of rational thinking and a rudimentary understanding of

airway care would do under the circumstances.

Beware of workbook questions in ANY workbook that goes with a text. I haven't

found ONE that didn't have quite a significant number of questionablely

formulated items. When something doesn't look right to you, seek further

insight.

And remember that the NREMT-P exam is not rational in any way. It's a " gotcha! "

exam that bears little or no relationship to real paramedic practice, regardless

of its boasts about task surveys and so forth.

Thank you for affording me this opportunity to make you quake in terror! Get

Rahm's book and study it, review the National Standard Curriculum, and

you'll do fine.

Best,

Gene

Re: Re: Airway Question

pardon, Sir, but the " Orange Book, Second Edition " was *at least* 6 years

old by the time you took your -A course.

I took my 81 hour -A course in 1976-7 with the Second Edition... and, IIRC,

we were the second or third class at that training center to use it (St

ph's Hospital Medical Center, Bloomington, IL).

ck

In a message dated 5/6/2010 16:03:43 Central Daylight Time,

lnmolino@... writes:

Part of the issue here is the 6th edition is a full 4 editions ago.

Granted even me a Basic knew that nasal intubation was a NO NO in the case

of a skull fracture.

Oh my EMT-A course in 1981 was with the brand new AAOS 2nd Ed.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/FF/N

Freelance Consultant/Trainer/Freelance CoFreelance Consultant/Trainer

_LNMolino@..._ (mailto:LNMolino@...)

(Cell Phone)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

In a message dated 5/6/2010 3:28:09 P.M. Central Daylight Time,

_medic0946@..._ (mailto:medic0946@...) writes:

Rick, you were correct. Nasal intubation should be avoided in the

possibility of basal skull fx.

>

> Ok group,

> I normally do more reading than talking on here, but I have a question

that is killing my brain, LoL. I'm studying for my NREMTP using the "

Caroline's Emergency Care in the Streets 6th Edition " student workbook.

>

> Under the " Airway Management & Ventilation " chapter the question states,

>

> You have a 42 y/o female extricated from a wrecked vehicle; she is

unconscious and has a depressed skull fracture at the back of her head. To

secure an airway would you choose,

>

> A. Blind nasotracheal intubation as the preferred technique.

> B. Tracheal intubation as the preferred technique.

> C. Cricothyrotomy as the preferred technique.

>

> I chose " B' as my answer, and was told (by the answers in the back of

the book) that the correct answer was " A " . Please correct me if I'm wrong

as

I am still learning, but have we not always been taught NOT to use

nasotracheal intubation if the pt has a skull fracture of any kind?

>

> Everyones input will be greatly appreciated, because I really need to

pass my test.

>

> Thanks,

> R.

>

> Democracy will cease to exist when you take away from those who are

willing to work and give to those who are not.

> Jefferson

>

>

>

>

>

> [Non-text portions of this message have been removed]

>

[Non-text portions of this message have been removed]