A standard of 56cm is reasonable)
Alternatively measure from tip of nose to earlobe to xyphoid and then add 15cm
Topical vasoconstrictors to both nares
Oxymetazoline or phenylephrine
Topical Anesthetics (5 min prior to procedure)
Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly
Anesthetize oropharynx, as well, to prevent gagging
Antiemetics
Ondansetron or metoclopramide 15 min prior may reduce gagging and nausea
Oxymetazoline or phenylephrine
Benzocaine, tetracaine, nebulized lidocaine (4 or 10%), lidocaine jelly
Anesthetize oropharynx, as well, to prevent gagging
Ondansetron or metoclopramide 15 min prior may reduce gagging and nausea
Sipping water may aid in esophageal passage
Withdraw to OP promptly if excessive coughing, gagging, choking or voice change
Insufflate air while listening over stomach
One study shows this discovers only 6% of malplacement
Should not be primary confirmation technique
Obtain abdominal xray
Check pH of aspirate
pH<5.5 in 99% of cases and has sen of 0.78 and spec of 0.86 at or below this level
One study shows this discovers only 6% of malplacement
Should not be primary confirmation technique
pH<5.5 in 99% of cases and has sen of 0.78 and spec of 0.86 at or below this level
Nasogastric tube placement
Gastric lavage
Esophageal foreign body removal with foley catheter
FAST exam
Acute abdominal series
Escharotomy
Theraputic peritoneal lavage
Balloon tamponade for massive GI bleeding