Nare "dilation" before nasal AFOI?

[vector2]

I was just wondering what your guys' thoughts were regarding this practice. I had an angioedema AFOI in the ER a few months ago and another CA-3 who was moonlighting down there popped in to lend a hand. The guys tongue and oropharyngeal tissues were so raw that even with lido neb, 4% spray, ketamine/versed/glyco, he couldn't tolerate a 5% jelly coated williams airway placement, so we decided to go nasal route. I spray the nares with afrin and lido and then the other resident placed a couple of increasingly sized jelly coated trumpets into each nare. Sprayed lido through the trumpet, removed them, scope goes down fine, tube in.

Just intuitively to me, the idea that some soft silicone tube is going to keep anything "dilated" once you remove it just doesn't make any sense, and if anything I feel like trying to shove in some big ass 36fr trumpet beforehand is just going to increase the chances of having a bloody passage when you do finally put the scope down. I would rather take a small jelly coated trumpet and just see which nare was the easiest pass, and then scope that one. Thoughts?

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[Robotic Wis-Hipple]

I was just wondering what your guys' thoughts were regarding this practice. I had an angioedema AFOI in the ER a few months ago and another CA-3 who was moonlighting down there popped in to lend a hand. The guys tongue and oropharyngeal tissues were so raw that even with lido neb, 4% spray, ketamine/versed/glyco, he couldn't tolerate a 5% jelly coated williams airway placement, so we decided to go nasal route. I spray the nares with afrin and lido and then the other resident placed a couple of increasingly sized jelly coated trumpets into each nare. Removed them, scope goes down fine, tube in.

Just intuitively to me, the idea that some soft silicone tube is going to keep anything "dilated" once you remove it just doesn't make any sense, and if anything I feel like trying to shove in some big ass 36fr trumpet beforehand is just going to increase the chances of having a bloody passage when you do finally put the scope down. I would rather take a small jelly coated trumpet and just see which nare was the easiest pass, and then scope that one. Thoughts?

Aside from possibly just assuring yourself that the 7.0 nasal tube is going to fit I agree with you.

 

[pgg]

I agree.

The best thing I can say for the dilating technique is that it smears the lidocaine jelly + vasoconstrictors deeper. I think that might be useful, sometimes.

 

[cchoukal]

...and I recently learned that this singular of nares is naris, not nare.

 

[Psai]

...and I recently learned that this singular of nares is naris, not nare.

But it has an s on it?

 

[deleted162650]

But it has an s on it?

So does Octopus.

 

[Psai]

So does Octopus.

the plural of which is octopodes which also has an s

 

[Ronin2258]

But it has an s on it?

Because it's a Latin noun. Third declension, if memory serves

 

[kidthor]

I never understood the point of serial dilation personally. You can't dilate a bony structure, and at best you'll repeatedly traumatize the mucosa. IMO what makes sense is a single placement of a nasal trumpet with the OD slightly bigger than the nasal tube's OD. Then place the nasal tube.

PS - too bad we can't (easily) use cocaine for nasal topicalization.

 

[Psai]

I never understood the point of serial dilation personally. You can't dilate a bony structure, and at best you'll repeatedly traumatize the mucosa. IMO what makes sense is a single placement of a nasal trumpet with the OD slightly bigger than the nasal tube's OD. Then place the nasal tube.

PS - too bad we can't (easily) use cocaine for nasal topicalization.

Why not? ENTs use it all the time

 

[pgg]

Why not? ENTs use it all the time

Word would get around and next thing you know every other patient will be demanding an awake nasal intubation.