Dental Case

[coffeebythelake]

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Does anyone really believe these soft and easily compressible nasopharyngeal airways are dilating anything? I could see checking for nasal patency... I haven't "dilated" since residency, nor does anyone where I work currently, though it's 100% peds.

Uh yeah, perhaps calling it dilation is a bit of a misnomer.. but that's typically what we mean when we apply the nasal trumpets. Apply lubricant, vasoconstriction, and test patency. Start with a smaller trumpet, then size up to a trumpet size that fairly closely match the ETT you actually intend to place. Or did you think that we were actually trying to make a small nose hole into a big nose hole?

 

[propadope]

Uh yeah, perhaps calling it dilation is a bit of a misnomer.. but that's typically what we mean when we apply the nasal trumpets. Apply lubricant, vasoconstriction, and test patency. Start with a smaller trumpet, then size up to a trumpet size that fairly closely match the ETT you actually intend to place. Or did you think that we were actually trying to make a small nose hole into a big nose hole?

I have seen my share of epistaxis from NPAs. I just try an appropriate sized softened nasal RAE. Try one side. Rotate/back up and redirect if needed avoiding excessive force. Try the other side and don’t hesitate to go oral. If you pass the tube nasally but notice tissue at the tip, use the Magills and grab the tip of the tube and pull it out of the mouth. Suction the tip of the tube with suction tubing (no Yankauer). Pull the proximal end of the tube so that the tip goes back into the pharynx and then proceed. Don’t pull the ETT completely out since if there is a bleed it will tamponade it.

 

[deleted87051]

I’ve been told one of my partners uses his gloved pinky finger to dilate/check patency. Kinda gross but also kinda makes sense.

 

[deleted162650]

Try one side. Rotate/back up and redirect if needed avoiding excessive force. Try the other side and don’t hesitate to go oral.

Giggidy

 

[propadope]

Giggidy

There you are!

 

[GassYous]

I know a few partners who dilate. I am not going to do it but I'm going to be a lot more cautious now and be much faster to abort the nasal attempt.

 

[Ronin786]

I like the red rubber method. The benefit is you don't give the patient a turbinectomy with the sharp tip of the ETT.

 

[deleted87051]

I like the red rubber method. The benefit is you don't give the patient a turbinectomy with the sharp tip of the ETT.

But isn’t it great when they say “doctor I can breathe do much better now.”😉

 

[propadope]

For peds I don’t themosoften. I use a stylet to preform the tube into a ‘pigtail’. When you take the stylet out there will be a nice big gentle curve. When you pass the tube through the nose, the tip should point anteriorly. This prevents the tube from getting hung up on the posterior wall of the pharynx. Once it’s in the oropharynx you can often direct the tube through the glottis by careful rotation without the need for the Magills.