Emergency Medicine at HCMC
Procedure Lab > Endotracheal Intubation

INDICATIONS

a)	Control of airway during resuscitation in unconscious or semiconscious patients
b)	Establish airway in upper airway obstruction secondary to infectious processes
c)	Artificial ventilation and usage of PEEP
d)	Laryngotracheal injuries
e)	Surgical procedures employing general anesthesia

CONTRAINDICATIONS

a)	Upper airway obstruction by a foreign body that may be pushed further into the trachea
b)	Neck injuries when suspected fracture or compromise of c-spine
c)	Severe injuries to trachea or esophagus changing anatomical relationships

TECHNIQUE

a)	Assemble laryngoscope and cuffed endotracheal tube
b)	Use stylet and have all necessary equipment readily available
c)	Make sure everything is working properly
d)	Position patient in sniffing position
e)	Hyperventilate with bag-valve-mask with 100% O2 prior to intubation
f)	Grasp laryngoscope with left hand and open mouth with right hand
g)	Advance blade along right side of tongue into vallecula and elevate if using a curved blade. If using a straight blade, lift epiglottis
h)	Visualize cords, suction if needed, pass endotracheal tube
i)	Remove stylet
j)	Ventilate patient and listen to both sides of chest

Figure 1-7. Direct laryngoscopy. A. Use of curved laryngoscope blade. B. Use of straight laryngoscope blade. (From Clinton. J. E. and Ruiz. E.: Trauma Life Support Manual. 1982.) C. Diagram of anatomy of larynx entrance exposed by direct laryngoscopy. (From AHA Advanced Life Support Slide Series. 1976.) D. Direct laryngoscopic view during tracheal intubation: exposure of arytenoids. E. Direct laryngoscopic view during tracheal intubation: exposure of glottis. The anterior commissure is not fully seen. The posterior commissure is below. (From Holinger. P. H. Anison. G. C. and Johnston. K. C.: Bronchoscopic and esophagoscopic cinematography. J. Thorac. Surg. 17:178. 1948.)

k)	Inflate cuff with 10cc air
l)	Use twill tape to secure tube
m)	Obtain chest XR to confirm placement

COMPLICATIONS

a)	Esophageal intubation
b)	Intubation of mainstem bronchus
c)	Mechanical tube problems
d)	Oral injury
e)	Anoxia from prolonged intubation attempt
f)	Tracheal injury
g)	Aspiration
h)	Hoarseness
i)	Sore throat
j)	Tracheitis
k)	Granuloma formation
l)	Vocal cord injury
m)	Subcutaneous emphysema

 

For more information contact Richard O. Gray MD.

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Copyright © 2000 HCMC Emergency Medicine. All rights reserved.
Manual last modified: Wednesday May 07, 2003.