2024 FSA Podium and Poster Abstracts

P025: BLIND NASAL INTUBATION AS A RESCUE STRATEGY IN DIFFICULT AIRWAY MANAGEMENT
Riaz Chowdhury, Medical Student; Rohit Jaishankar, Medical Student; Ross University School of Medicine

Introduction/Background: Managing the airway in emergency situations, especially in patients with challenging medical histories, presents significant clinical challenges. We present a case of a 75-year-old gentleman with multiple comorbidities admitted to the Emergency Room (ER) with acute hypercapnic hypoxemic respiratory failure requiring emergency intubation. The patient’s medical history included chronic hypertension, cerebral vascular accident (CVA) with residual paralysis, dementia, seizure disorder, and a percutaneous endoscopic gastrostomy tube.

Methods: Following failed attempts at conventional intubation due to locked jaw (trismus) induced by succinylcholine administration, and subsequent unsuccessful nasal fiberoptic intubation, blind nasal intubation was performed as a rescue strategy. Prior to intubation, nasal cavities were meticulously prepared using Oxymetazoline for vasoconstriction and Surgi-lube for lubrication, facilitating a smoother insertion of the endotracheal tube. Following assessment and preparation of nasal cavities, a cuffed endotracheal tube (ETT) was advanced under guidance from breath sounds.

Results: Blind nasal intubation was successful, confirmed by clinical observation and imaging. The patient’s condition improved, and subsequent interventions addressed associated complications, including tension pneumothorax which was promptly identified by chest radiography and managed through percutaneous decompression by interventional radiology.

Discussion/Conclusion: This case underlines the efficacy of blind nasal intubation as a rescue strategy in challenging airway management scenarios, particularly when conventional methods fail. While not the gold standard, blind nasal intubation offers a feasible alternative, especially in cases of limited mouth opening or compromised airway anatomy. This approach is also less invasive and requires fewer logistical resources than surgical cricothyrotomy, which typically necessitates an operating room and ENT specialist.

While blind nasal intubation carries potential risks, such as epistaxis, pneumothorax, and pharyngeal perforation, which necessitate vigilance, it remains a critical technique that can be lifesaving when judiciously applied in emergency situations. The unique challenges of this case also emphasize the importance of a collaborative, multidisciplinary approach in managing complex airway cases, highlighting the synergy between anesthesiology, emergency medicine, and surgical teams.

We advocate for further research into the training protocols and guidelines for blind nasal intubation to enhance its safety profile while better understanding its utility in optimizing patient outcomes in emergency airway management.