Which of the following is a potential indication for nasal intubation?

• A. Cervical spine injury
• B. Patient with RR of 10
• C. Blood or vomit in the oral cavity
• D. Cervical spine injury with facial injuries

Answer: (B)

Securing the airway is needed when ventilation is inadequate or likely to deteriorate. Nasal intubation is a route to establish a protected airway, especially when the oral route is not ideal due to facial injuries, restricted mouth opening, or the need to keep the mouth free for other procedures. A patient with a respiratory rate of ten is showing hypoventilation and fatigue, signaling the need for definitive airway protection to prevent impending respiratory failure or aspiration. In contrast, cervical spine injury with facial injuries raises concerns about nasal access because nasal routes can be risky with facial trauma or possible skull base involvement, and blood or vomit in the airway makes rapid oral suctioning and protection of the airway more urgent; nasal access can complicate those steps. A cervical spine injury alone also doesn’t identify a nasal route as the preferred choice without considering the facial trauma and airway plan.