Why is nasopharyngeal suctioning contraindicated when caring for a frontal skull fracture patient?
Topic Resources Part of pre-intubation and emergency rescue breathing procedures, the head tilt–chin lift maneuver and the jaw-thrust maneuver are 2 noninvasive, manual means to help restore upper airway patency when the tongue occludes the glottis, which commonly occurs in an obtunded or unconscious patient. Treatment of suspected upper airway obstruction in obtunded or unresponsive patients Part of initial emergency treatment for apnea or impending respiratory arrest Improvement of airway patency during BVM ventilation and sometimes during spontaneous breathing Confirmation of apnea Absolute contraindications Relative contraindications
Tilting the head or otherwise moving the neck is contraindicated in a patient with a possible cervical spine injury, but maintaining an airway and ventilation is a greater priority. In the setting of a possible cervical spine injury, the jaw-thrust maneuver, in which the neck is held in a neutral position, is preferred over the head tilt–chin lift maneuver. Complications are uncommon and include
The sniffing position—only in the absence of cervical spine injury
Head and neck positioning to open the airway: Sniffing positionA: The head is flat on the stretcher; the airway is constricted. B: The ear and sternal notch are aligned, with the face parallel to the ceiling (in the sniffing position), opening the airway. Adapted from Levitan RM, Kinkle WC: The airway Cam Pocket Guide to Intubation, ed. 2. Wayne (PA), Airway Cam Technologies, 2007. If cervical spine injury is a possibility
Head tilt–chin lift
Jaw thrust
Jaw thrust
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Click here for Patient Education Copyright © 2022 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved. When should a nasopharyngeal airway not be used?Absolute contraindications for NPA and NT intubation include signs of basilar skull fractures, facial trauma, and disruption of the midface, nasopharynx or roof of the mouth.
For which of the patient is the insertion of a nasopharyngeal airway contraindicated?An NPA is generally contraindicated in new postoperative rhinoplasty or septoplasty patients because it can cause tissue trauma or damage the newly altered structural integrity of the surgical site. The nasal passages may also be occluded with surgical packing.
What is the most serious potential complication of nasopharyngeal airway insertion with facial trauma?Cribriform insertion is perhaps the most catastrophic complication of a nasopharyngeal airway, but it is also the least likely. Improper technique can cause the tube to enter the cribriform plate, causing soft tissue or skull damage, and potentially even penetrating the brain.
What is the absolute contraindication for an oral airway?There are only two absolute contraindications to airway management: A competent legal adult who declines airway management after learning of the risks and benefits. A patient with a do-not-resuscitate (DNR) order that requests no airway management, or that prohibits certain forms of airway management.
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