Why should the nasopharyngeal airway not be used if there is evidence of fluid coming from the nose or ears?

Answer 1

A nasopharyngeal airway is contraindicated in the following situations:

- Evidence of Battle's Sign (bruising behind the ear)

- Severe facial of cranial injuries.

- Signs of cerebro-spinal fluid (CSF) or raccoon eyes.

NB: the clear fluid coming out of the patient's nose or ears is most likely CSF. CSF protects and insulates the brain, and can leak from the skull if there is head trauma.

The above situations indicate the possibility of a traumatic brain injury (previously termed 'head injury'). The risk of the nasopharyngeal airway intruding with the brain is fairly high so as a precaution, an alternative airway is used. An oropharyngeal airway would be a better alternative in a patient with suspected traumatic brain injury.

A nasopharyngeal airway, (aka NPA or a nasal trumpet), is a tube inserted into the nasal passageway of an unconscious victim to provide an open airway (when unconscious the jaw muscles relax and the tongue to falls back obstructing the airway).

NPA is contraindicated (not used) in patients with severe head or facial injuries, or a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct contact with brain tissue.

Answer 2

The clear fluid may be cerebrospinal fluid ( CSF), which would indicate a brain or spinal injury (skull fracture or severe damage to the spine).

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In a trauma patient, clear fluid draining from the nose or ears is considered cerebrospinal fluid (CSF) until proven otherwise. One would not use a nasopharyngeal (NP) airway in this patient due to the (small, but theoretically possible) risk of cribriform plate fracture and passing the NP airway into the cerebrum.

An oropharyngeal airway would be a better choice in this patient, allowing one to ventilate the patient until a definitive airway could be established, if indicated.

The halo test can be used to check if the fluid is, in fact, CSF. A small amount of the fluid is allowed to drain onto a 4x4 or filter paper. Blood will collect in the center, and if it is CSF, a clear-yellow ring will surround the blood. This is not a terribly specific test, but allows one to crudely determine if CSF rhinorrhea is present.
This may indicate a brain injury.

Answer 3

A nasopharyngeal airway, (aka NPA or a nasal trumpet), is a tube inserted into the nasal passageway of an unconscious victim to provide an open airway (when unconscious the jaw muscles relax and the tongue to falls back obstructing the airway).

• The clear, straw like fluid coming out of the ears is called cerebro-spinal fluid [CSF]. CSF is the liquid that lines the space between the skull and brain to protect this sensitive organ. In the event of a traumatic brain injury (commonly known as head trauma), this fluid may leak out from the ears or nose due to structural damage.
• Should a traumatic brain injury be suspected, the patient needs to have medical intervention urgently. Complications of brain injury include cerebral compression among many other serious conditions.
• Introducing a nasopharyngeal airway, nasogastric tube, or attempting to nasally intubate a person with basilar skull fractures carries the risk of inadvertently passing the device through the fracture and into the skull damaging the brain.
• NPA is contraindicated (not used) in patients with severe head or facial injuries, or a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct contact with brain tissue.

The theory to test for this is simple enough. Cerebrospinal fluid (CSF) and blood don't mix, much like water and oil. Put a dab of the patient's blood on a piece of gauze and see if the blood and CSF separate. This looks a little bit like a halo, so this test is called a halo test.
A nasopharyngeal airway, (aka NPAor a nasal trumpet), is a tube inserted into the nasal passageway of an unconscious victim to provide an open airway (when unconscious the jaw muscles relax and the tongue to falls back obstructing the airway).

NPA is contraindicated (not used) in patients with severe head or facial injuries, or a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct contact with brain tissue.