Endotracheal tube intubation

Endotracheal tube intubation

Indication:
1.Before general anesthesia
2.cardiac or respiratory arrest
3.Inadequate ventilation
4.Failure to protect the airway from aspiration

Contraindications:
1.Trauma in the respiratory tract
2.Blood in mouth
3.Tumour in the airway passage
4Pharyngel and laryngeal tissues having:
i.Burn
ii.Edema
iii.Infection

Equipment
1.Laryngoscope
It is of two types:
i.Macintosh(3-4)
ii.Miller (2-3)
2.Endotracheal tube (b/w 7 to 8mm in diameter)
3.Mechanical ventilator
4.Syringe
5.Gloves
6.Stylet
7.Tape
8.Stethoscope
9.CO2 Detector

Preparation:
i. Check the well working of light of laryngoscope
ii.check the integrity of a balloon of endotracheal tube
iii. Insert stylet in the endotracheal tube (make sure tip do not extend beyond the end of the tube)
iv.Adjust the head into sniffing position
-Flexion of neck
-Extension of head
Which facilitates maximum visualization
v.Pre-oxygenate the patient prior to intubation
vi. Position your body for proper binocular vision

Procedure:
1. Sellick maneuver is done (Firm pressure at circoid cartilage which compresses esophagus between cervical vertebrae and circoid cartilage.
2. Hold the laryngoscope in the left hand
3. Open the patient’s mouth with the right hand and insert a laryngoscope to the right of the patient’s tongue.
4. Gradually move the bladder to the center of your mouth pushing the tongue to the left.
5.Visualize larynx by moving epiglottis
The placement of the blade depends upon whether a curved or straight-bladed laryngoscope is used
>For Curved blade: place the tip of the blade at vallecula(space between the base of tongue and epiglottis)
>For Straight blade: tip of the blade passes the epiglottis
6.after using any of the blade(curved or straight), lift the laryngoscope anteriorly or lift the laryngoscope forward and upward at 45~
7. Hold endotracheal tube in the right hand and insert it into the right side of the mouth
8. Remove stylet when the balloon is 3-4cm beyond vocal cord
9. Advance the tube further.
10. Inflate the baloon with minimum air pressure to prevent air leaks during tidal volume ventilation from bag (less than 10cc is required).
11. Distance is measured by rule of thumb in Adults it is 22cm.

Confirmation:
1.CO2 detection
2.Auscultation
i.Abdominal
ii. Lungs >> if diminished sounds are heard in the left lung, withdraw the tube until symmetrical sounds are heard
3. Chest radiography… it does not detect esophageal intubation

Securing tube:
1.ETT holder
2.Tap (attach it to the cheek—–to the tube—-to other cheek of another side)

Complications:
complications of Laryngoscopy
Vomitting
Aspiration of gastric contents causing pneumonia and pneumonitis
Laryngospasm
Pharungospasm
Trauma to the teeth, lips and vocal cord

Complications of Endotracheal tube intubation:
Most common is the Unrecognized esophageal intubation which can lead to the
i.Hypoxemia
ii.Hypercapnia
iii.Death

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