INTUBATION

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Advantages/Complications of Tracheal Intubation

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Advantages of tracheal intubations:

Airway patency

Protects the airway Maintains patency during positioning ventilation over a long period of time without intubation can lead to gastric distention and regurgitation

Control of ventilation

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Advantages of tracheal intubations:

Route for inhalation anesthesia and emergency medications

A - Atropine L - Lidocaine E - Epinephrine

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Complications of tracheal intubation:

Trauma to the lips, teeth, and soft tissues of the airway.

Awareness meticulous technique

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Complications of tracheal intubations:

Laryngospasm

common when extubation is done when the patient is in a semiconscious state extubation should be done when the protective laryngeal reflex has returned

Postintubation hoarseness and sore throat

due to mechanical presence of the tracheal tube

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Preparation of Equipment
Assemble pharyngeal airways in assorted sizes

Nasopharyngeal Oropharyngeal
Batteries Light bulb Blades; curved/straight (Macintosh or Miller)

Inspect laryngoscope for serviceability

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Selection of laryngoscope blade (preference)

Macintosh is a curved blade whose tip is inserted into the vallecula (the space between the base of the tongue and the pharyngeal surface of the epiglottis). Most adults require a Macintosh number 3 or 4 blade.

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Selection of laryngoscope blade (preference)

Miller is a straight blade that is passed so that the tip of the blade lies beneath the laryngeal surface of the epiglottis. The epiglottis is then lifted to expose the vocal cords. Most adults require a Miller number 3 blade.

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Preparation of Equipment Inspect endotracheal tubes

Tube size

adult male 8 mm to 9 mm tube adult female 7 mm to 8 mm tube

Tube length- extend from the lower incisor to a point in cricoid cartilage. Endotracheal tube cuff

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Preparation of Equipment
Lubrication Laryngeal sprays

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Inspect resuscitator (AMBU bag) for serviceability

Bag Mask

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Inspect stethoscope
Diaphragm Earpieces Tubing

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Gather and prepare all equipment necessary for an emergency Airway

Scalpel handle Surgical blades Curved hemostats Endotracheal tube Syringe

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Intubation Technique
ventilate with 100 percent oxygen for approximately 1 min Position bed height to bring the patient's head to a mid-abdominal height Long axis of the oral cavity, pharynx, and trachea lie almost in a straight line

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Intubation Technique
introduce the blade into the right side of the patient's mouth move the blade posteriorly and toward the midline, sweeping the tongue to the left and keeping it away from the visual path with the flange of the blade. the lower lip is not being pinched by the lower incisors and laryngoscope blade advance the laryngoscope until the epiglottis is in view
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Intubation Technique
lift the laryngoscope upward and forward insert the endotracheal tube from the right with its concave curve facing downward and to the right side of the patient maneuver the endotracheal tube into the larynx
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Intubation Technique
inflate the cuff and apply positive pressure ventilation while the assistant auscultates secure the endotracheal tube in position

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 topical lidocaine or phenylephrine should be applied to the nasal passages 0.5-1.0% Neosynephrine and 4% Lidocaine, mixed 1:1 should also give satisfactory results generously lubricate the nares and endotracheal tube ET tube should be advanced through the nose directly backward toward the nasopharynx
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Nasotracheal intubation technique

Nasotracheal intubation technique

loss of resistance marks the entrance into the oropharynx laryngoscope and forceps can be used to guide the endotracheal tube into the trachea under direct vision for awake spontaneous breathing patients, the blind technique can be used
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Confirmation of tracheal intubation:

Direct visualization of the ET tube passing through the vocal cords CO2 in exhaled gases Bilateral breath sounds Absence of air movement during epigastric auscultation

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Confirmation of tracheal intubation:

Maintenance of arterial oxygenation Chest X-ray: the tip of the ET tube should be approximately at the level of the aortic arch.

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Extubation
ensure that the patient is recovering is breathing spontaneously with adequate volumes evaluate the patient's ability to protect his airway by observing whether the patient responds appropriately to verbal commands
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Extubation steps:
Oxygenate patient with 100 percent high flow O2 for 2 to 3 minutes if secretions are suspected in the tracheobronchial tree, remove them with a suction catheter through the lumen of the endotracheal tube ensure that the patient is not in a semiconscious state
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Extubation steps:
turn the patient onto his side if he is still unconscious unsecure the endotracheal tube from the patient's face deflate the cuff and remove the endotracheal tube quickly and smoothly during inspiration

continue to give the patient O2 as required

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