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A) ENDOTRACHEAL
INTUBATION
1)
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
2) Co
2) 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
3) Tec
3) 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
4) Com
4) 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
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