Endotracheal intubation

for teaching students

1. ENDOTRACHEAL INTUBATION Dr. N.K. Agrawal Prof, Dept. Of Anaesthesiology, JNMC, Sawangi. 1

2. what is endotracheal intubation? what are the indications of intubation? equipment required for intubation technique of intubation confirmation of intubation ventilation complications extubation 2

3. Endotracheal intubation is the placement of a special tube in trachea What is endotracheal intubation ? 3

4. To secure airway to supply oxygen general Anesthesia Cardio pulmonary resucitation ventilatory therapy in ICU What are indication of intubation? 4

5. size of tube 0-1 yrs. 2.5 to 3.5 mm ( plain ) 1-3 yrs. 4 . to 5 mm 4-6 yrs. 5 to 6 mm 6-10 yrs. 6 to 7 mm ( cuffed ) adult female . 7 to 8 mm adult male . 8 to 9 mm laryngoscope magill's forceps Stethoscope syringe source for ventilation suction Equipments 5

6. Different sizes of cuffed and plain ETT 6

7. Laryngoscope 7

8. Magill’s forceps ( different sizes) 8

9. Syringe to inflate cuff 9

10. suction 10

11. Raise the head by 5cm with a block or ring pillow Technique of intubation 11

12. Extension at atlanto-occipital joint Flexion at neck 12

13. 13

14. hold the laryngoscpoe with LEFT hand irrespective of dominant hand open the mouth with right hand index finger with support of thumb introduce Laryngoscpoe from right angle of mouth shift the tongue to left go in press over tongue see epigllotis lift ît watch for voccal cords 14

15. 15

16. take the tube in right hand introduce under vision confirm placement by auscultation if tube is cuffed inflate the cuff with syringe 16

17. connect the source to tube confirmation a) by auscultation b) by chest expansion c ) by bag movement d) end tidal CO2 fix the tube with adhesive 17

18. conection to ventilate with ambu's bag anesthesia machine ventilator 18

19. Tachycardia rise in blood pressure Increase in secretions Laryngospasm bronchospasm Side effect of intubations 19

20. tube in oesophagous endobrocheal intubation trauma to lips tooth Bleeding Leak Trachities Cough sore throat barotrauma to Lungs Complications 20

21. increase in supply of O2 to give general anesthesia improove exhalation of C02 Effect of intubation 21

22. I t is advisable if the cause is treated throat suction Laryngoscopy Reflexes Spo2 adequate respiration level of consciousness extubate Extubation 22

23. if mouth opening restricted anterior vocal cords burn contracture one may require other options like fibro optic intubatioñ awake intubation retrogate intubation supra epiglotic device Failed or difficut intubation 23

24. Laryngeal mask airway (LMA) 24

25. 25