When clear fluid is coming from the nose or ears, should you insert a Nasopharyngeal Airway (NPA)?

In cases where clear fluid is present from the nose or ears, it is crucial to understand the potential indication of a skull base fracture, which could also suggest cerebrospinal fluid (CSF) leakage. When these signs are present, inserting a nasopharyngeal airway can pose a significant risk. The anatomy involved means that the NPA may not only fail to provide the intended airway management but could also exacerbate any existing injury, potentially leading to further complications such as meningitis or exacerbated trauma to the central nervous system.

Recognizing this, the guideline is to avoid the use of an NPA when there is evidence of clear fluid drainage, especially considering the possibility of trauma that includes the skull and facial structures. In contrast, the presence of inhalation burns suggests a different kind of emergency and would require immediate and alternate airway management measures, but the central concern with clear fluid escape is the risk associated with inserting a device that could intrude into a compromised area.

Therefore, the proper response in this scenario is to refrain from NPA insertion when there are indicators of a serious head injury with possible CSF involvement, ensuring patient safety and aligning with TCCC protocols for trauma management.