Basilar Skull Fracture and Oral Grastro Tube (OGT)

  1. 0 I am a third yr nursing student. I would like to know why is it that when a patient as Base of Skull Fracture, he or she is unable to have OGT inserted? This was asked by my preceptor and I cant figure out the answer. Would it be because of the skull anatomy which includes the temporal, occipital, sphenoid and the ethmoid bone?
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  3. Visit  sandrang1993} profile page

    About sandrang1993

    From 'Singapore, Singapore (general), SG'; Joined Dec '12; Posts: 5.

    11 Comments so far...

  4. Visit  ckh23} profile page
    1
    I wouldn't say that an OGT with a basilar skull fracture is an absolute contraindication. Plenty of people in the trauma unit have an OGT with a basilar skull fx. Was it specifically an OGT or an NGT. An NGT would be a different story.

    This picture should show you why you don't put an NGT in a people with head/facial trauma.

    http://ars.els-cdn.com/content/image...996197-gr1.jpg
    GrnTea likes this.
  5. Visit  emtb2rn} profile page
    0
    If the pt is tubed you can slide the ogt right down alongside the ett.
  6. Visit  akulahawkRN} profile page
    0
    With a basilar skull fracture, an OGT doesn't get anywhere near the base of the skull, if it's properly inserted. NGT is contraindicated because it can go through the fracture and into the cranial vault. Same for "nasal trumpet" or NPA airway adjuncts. If the patient is conscious when it's placed, an OGT could cause too much movement as the patient has to swallow to assist in placement. Patient movement could be the contraindication, more than anything else.

    Just could be.
  7. Visit  ckh23} profile page
    1
    Quote from akulahawk
    With a basilar skull fracture, an OGT doesn't get anywhere near the base of the skull, if it's properly inserted. NGT is contraindicated because it can go through the fracture and into the cranial vault. Same for "nasal trumpet" or NPA airway adjuncts. If the patient is conscious when it's placed, an OGT could cause too much movement as the patient has to swallow to assist in placement. Patient movement could be the contraindication, more than anything else. Just could be.
    I hope awake patients aren't getting OGTs.
    Sun0408 likes this.
  8. Visit  Esme12} profile page
    2
    I think you need to ask your preceptor again the question......OGT is the recommendation for a basilar skull fracture.....it the NGT that is considered contraindicated.

    http://www.ramcjournal.com/2008/mar08/spurrier.pdf
    GrnTea and chare like this.
  9. Visit  Sun0408} profile page
    0
    I have placed many OGT on our trauma pts with facial fx, orbital, skull fx etc.. An NGT is contraindicated.
  10. Visit  sandrang1993} profile page
    0
    So i guess it's NGT that's not recommended. Only because it might traumatize e injury further? Probably because of e fracture?
  11. Visit  KelRN215} profile page
    1
    Quote from sandrang1993
    So i guess it's NGT that's not recommended. Only because it might traumatize e injury further? Probably because of e fracture?
    No, because the NG could end up in the brain... and kill the patient. See the article Esme posted.
    Esme12 likes this.
  12. Visit  Esme12} profile page
    1
    Since you did not look at the article (which I suggest you do for it is very good.) I will explain.... for this mistake will kill someone!

    The cribriform plate is the name given to a specific area of the human skull. It is part of the ethmoid bone, which is responsible for separating the brain from the nasal cavity. The cribriform plate attaches to a structure located on the frontal bone of the skull known as the ethmoidal notch. The roof of this structure also connects to the nasal cavities in the skull.


    The cribriform plate is located directly posterior to the nares and is part of the ethmoid bone. It is very porous in nature and weaker than the surrounding portions of the ethmoid. It is easily fractured, and can be seen is association with basilar skull fractures. This is one source for rhinorrhea in patients with these fractures....the runny nose is actually CSF! (cerebral spinal fluid!)

    So you insert the NGT into the brain.....an unintentional frontal lobotomy.



    http://www.skullbaseinstitute.com/pa...ase-trauma.htm
    Last edit by Esme12 on Dec 11, '12
    KelRN215 likes this.
  13. Visit  FDW630} profile page
    1
    Quote from ckh23

    This picture should show you why you don't put an NGT in a people with head/facial trauma.

    http://ars.els-cdn.com/content/image...996197-gr1.jpg
    Eep!!
    GrnTea likes this.
  14. Visit  GrnTea} profile page
    0
    Quote from sandrang1993
    I am a third yr nursing student. I would like to know why is it that when a patient as Base of Skull Fracture, he or she is unable to have OGT inserted? This was asked by my preceptor and I cant figure out the answer. Would it be because of the skull anatomy which includes the temporal, occipital, sphenoid and the ethmoid bone?

    Because your instructor is confused, or because you are. It's NG tubes, nasogastric, that you don't put into people with fractures in the base of their skulls, because you can shove it right into their brains. OGT, orogastric tubes, inserted through the mouth into the esophagus and thence to the stomach, can be placed carefully to be sure they don't divert upwards towards that fractured skull floor and that they don't track right down next to the ET tube into the lungs.


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