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Discussion

When don't you insert an ET tube?

I may have got it wrong but as a student I am certain one of my preceptors said "You never insert an ET tube in this case" and I can't remember what it was. Can any of you enlighten me please. (I wouldn't have been doing it but it was just part of her education to me). I have put down A & E as one of four places I'd like, if accepted as a grad student. She was an awesome preceptor and I learnt a lot from her in the two weeks I was there. Just wish I could remember as it was back in 2002. Like this instance are there any trauma situations where certain practices which are normal A & E procedures, contra indicated for patients and would you mind sharing them with me please? There's a lot I don't know but I'd like to be a little better prepared in case I do get that area.

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  • Experts

One of the injuries where you wouldn't insert an NGT is with facial (Le Fort) frractures. Another time is with some types of skull fractures or with a facial gunshot wound. Good luck.

  • Author

Thanks so much. really appreciate this.

Blunt trauma to neck incase of a trachael injury. Usually requires a surgical airway.

  • Experts

Ooops - I just re-read this post. I'm sorry that I posted about NGT not ETT.

Might have been referring to epiglottitis, an infection mostly affecting small children that can lead to airway obstruction. In these cases, intubation is often not performed in the ER, but rather in the OR. In the OR, they have better control of the situation in the event that intubation fails and a surgical airway is needed.

Some people even advise holding off on venipuncture and IV starts until the airway is managed in these kids, since pain and anxiety can increase the pt's chance of developing an obstructed airway.

A basilar skull fx; d/t possibility of defect in sinus floor. ET can end up in the sinus space

My mistake; it's NGT's that you don't insert with this injury!

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