> Why does the ATLS bother to teach us of the risk of brain penetration when
> putting objects up the nose in trauma, when the risk is apparently
> "imaginary"?
> I don't think I imagined seeing CT's of brains with NG tubes coiled up in
> them either. But maybe as NP tubes are bigger and not floppy they are less
> likely to go that way...is that the point?
> Nicky Drake
> SpR Chertsey
>
Yes.
NG tubes and epistats are small and stiff and go into the cranium through BOS
fractures (plenty of xrays and scans showing this).
Naso-pharyngeal airways are soft and pliable. I have heard that in the USA NG
tubes are inserted into head injured patients by passing a nasopharyngeal,
putting the NG tube down the nasopharyngeal and then cutting off the
nasopharyngeal.
As to why ATLS courses teach things that are wrong. You have just found the
big problem with didactic courses that are designed for basic education of very
junior doctors. They oversimplify. The problem then is that the oversimplified
didactic teaching gets regarded as gospel.
Tim.
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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