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Module 3: The Patient - Advanced Knowledge

Oral vs. nasal


Oral Nasal

Advantages:

  • May be better tolerated
  • No need to anesthetize nasal passages
  • Larger ETT possible
  • Shorter route
  • Possibly more acceptable for post-operative care in ICU

Disadvantages:

  • Less direct pathway – sharp angle from the oral cavity into the larynx
  • Easy to stray from midline (use of an oral intubating device helps)

Advantages:

  • Allows surgical access to oral cavity
  • Possible in patients with very limited or no mouth opening
  • Better choice if gag reflex persists despite best topicalization
  • After entering naso-pharynx, the glottis is usually very apparent

Disadvantages:

  • Passage through the nose is usually the most difficult part of the procedure and least well tolerated
  • ETT size limitation
  • Potential for epistaxis
  • Potential for bacteraemia

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Which nostril?

Ask the patient to sequentially block each nostril and take a deep breath—they will be able to indicate which is more patent. Studies have indicated that the left nostril is more likely to be an easier passage1.

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Tips

Inserting the ETT into the nose:

  • Use a well lubricated ETT
  • Use topical vasoconstrictor to nasal mucosa
  • Insert at right angles to the face2
  • Pass along the floor of the nose to the nasopharynx

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Continue to: Module 4: Medications