"NG in the Haid"
                        ===============

 - "Concerning the literature on intracranial insertion of the NG tube, see the
   following articles. It is more than one case of intracranial insertion and
   well-described:

   1) Fremstad JD  and Martin SH. Lethal complication from insertion of NG after
   basilar skull fracture. J Trauma 18:820, 1978

   2) Fry ENS. Positioning of NG tubes. BMJ 1:110, 1978

   3) Gustavsson S et al The accidental introduction of an NG tube into the
   brain. Acta Chir Scand 144:55, 1978

   4) Seebacher J et al. Inadvertent intracranial introduction of an NG tube:
   complication of severe maxillofacial trauma. Anesthesiology 42:100, 1975

   5) Wyler Ar and Reynolds AF. Intracranial complication of NG intubation J
   Neurosurg 47:297, 1977

   6) Young RF. Cerebrospinal fluid rhinorrhea following nasogastric intubation
   J Trauma 19:789, 1979

   7)  Galloway DC and Grudis J. Inadvertent intracranial placement of NG tube
   through a basilar skull fracture. South Med J  72:240, 1979

      "No doubt this *does* occur.  A literature search continues to
   reveal a handful of case reports per year on this subject submitted, no
   doubt, by junior surgery and emergency medicine faculty with too much
   time on their hands.  My comment was actually intended as a joke.
   Nevertheless, intracranial penetration appears to occur mainly with
   *massive* basilar skull fracture although occasional reports identify this
   complication in the presence of an intact cribiform plate in neonates.
   Anecdotally the passage of a soft nasotracheal tube prior to NG tube
   placement is said to significantly lesson the chance of this occuring."