2nd time learning #1 rule in Fiberoptic intubation. Oral intubation not easier.
It was hard not to laugh or point out the mistake. Best lessons learned by the student when self realized. Lessons learned by Ashraf the Resident.
Nasal Intubations went so much more smoothly.
The acute angle around the base of the tongue into the glottic opening much different than the gradual path from the back of the nasopharynx into the glottic opening.
I am not afraid of nasal secretions.
I would be cautious about anticoagulant and antiplatelet use or hemophiliac patients.
Basal skull fractures with clear copious nasal secretions or halo sign positive also to be cautious of.
Use the same endotracheal tube size orally that you would use for any D.L. or V.L. intubation.
For nasal intubation, use the largest endotracheal tube that would fit that nasopharynx. Tight fit. Larger and wider than the salem sump used for gastric decompression. Likely 7.0 or 7.5 endotracheal tube size.