Episode
Podcast 1003: Nasal Intubation
- Podcast
- Emergency Medical Minute
- Published
- Apr 27, 2026
- Duration seconds
- 541
- Processing state
not_requested
Actions
POST https://stenobird.com/v1/public/podcasts/emergency-medical-minute-972156/episodes/podcast-1003-nasal-intubation/transcription-requests
Idempotently request low-priority transcript generation for this episode.GET https://stenobird.com/podcast/emergency-medical-minute-972156/podcast-1003-nasal-intubation.md
Read the agent-friendly Markdown representation of this episode resource.
Summary
Contributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point for the ETT (nare v.s. mouth). Nasal Intubations are seldom preferred to oral intubations as they carry risk for inducing bleeding from trauma to the nasal passages. Indications for nasal intubations include: Anatomical abnormalities that may make access through the mouth difficult (i.e. tumors, macroglossia, or rare dental hardware that clenches the jaw shut). Physiological states such as severe angioedema. Nasal intubations are often done with the patient awake and could be advantageous if the patient is presenting in a severely hypoxic state such that prolonged hypoxia in a traditional RSI protocol may be detrimental. A 2023 retrospective analysis in Germany found that nasal intubations were associated with requiring less sedation than oral intubations and had more spontaneous breathing during hospitalization than oral intubations. How is a nasal intubation performed? Consider the use of an anxiolytic medication such as versed to calm the patient down but not fully sedate them. If there is adequate time without immediate patient compromise, consider glycopyrrolate to reduce airway secretions and dry up the mucous membranes. Consider the use of Afrin or other local vasoconstrictor in target nare to minimize epistaxis. Use 5% lidocaine ointment and lubricate an NPA and place it into the target nare. This will allow for local anesthesia as well as help to open up the nare slightly more. Take 5% lidocaine ointment and place it on a tongue depre…