Transcript 5Intubatn - lgh

INTUBATION
REVIEW
SFC HILL
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Advantages/Complications of
Tracheal Intubation
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Advantages of tracheal intubations:
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Airway patency
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Protects the airway
Maintains patency during positioning
Control of ventilation
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ventilation over a long period of time without
intubation can lead to gastric distention and
regurgitation
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Advantages of tracheal intubations:
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Route for inhalation anesthesia and
emergency medications
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N - Narcan
A - Atropine
L - Lidocaine
E - Epinephrine
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Complications of tracheal intubation:
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Trauma to the lips, teeth, and soft tissues of
the airway.
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Awareness
meticulous technique
Bronchial intubation
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frequent complication
auscultation of the chest bilaterally
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Complications of tracheal intubations:
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Laryngospasm
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common when extubation is done when the
patient is in a semiconscious state
extubation should be done in a relatively deep
anesthesia or when the protective laryngeal
reflex has returned
Postintubation hoarseness and sore throat
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due to mechanical presence of the tracheal
tube
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Preparation of Equipment
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Assemble pharyngeal airways in assorted
sizes
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Nasopharyngeal
Oropharyngeal
Inspect laryngoscope for serviceability
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Batteries
Light bulb
Blades; curved/straight (Macintosh or Miller)
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Selection of laryngoscope blade
(preference)
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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)
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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
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Tube size
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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 midway between the cricoid cartilage
and Louis's angle (the sternal angle) on the
patient
Endotracheal tube cuff
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Preparation of Equipment
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Malleable stylet (should not extend past
Murphy's eye)
Lubrication
Laryngeal sprays
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Inspect resuscitator (AMBU bag) for
serviceability
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Bag
Mask
Intake valve
Valve body with relief valve
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Inspect stethoscope
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Diaphragm
Earpieces
Tubing
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Gather and prepare all equipment
necessary for an emergency Airway
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Scalpel handle
Surgical blades
Curved hemostats
Endotracheal tube
Syringe
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Intubation Technique
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ventilate with 100 percent oxygen for approximately
1 min
Position bed height to bring the patient's head to a
mid-abdominal height
Flex the cervical spine and extend the head at the
atlanto-occipital joint
Long axis of the oral cavity, pharynx, and trachea lie
almost in a straight line
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Intubation Technique
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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
ensure 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
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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,
midway between the cricoid cartilage and the sternal
angle
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Intubation Technique
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inflate the cuff and apply positive pressure
ventilation while the assistant auscultates
secure the endotracheal tube in position
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Curved Blade Technique
The curved blade technique is essentially
similar. The only difference being when the
epiglottis is in view, advance the tip of the
laryngoscope blade into the vallecula, formed
by the base of the tongue and the epiglottis;
lift upward and forward.
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Nasotracheal intubation technique
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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
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loss of resistance marks the entrance into the
oropharynx
laryngoscope and Magill 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:
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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:
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Condensation (fogging) of water vapor in the tube
on exhalation
Refilling of reservoir bag during exhalation
Maintenance of arterial oxygenation
Chest X-ray: the tip of the ET tube should be
between the carina and thoracic arc or
approximately at the level of the aortic arch
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Extubation
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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:
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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:
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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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