Endotracheal intubation

These slides make you more competent in introducing endotracheal tube.

1. ENDOTRACHEAL INTUBATION BY ADNAN QADIR

2. It is the procedure in which an endotracheal tube is inserted through the nose or mouth into the trachea. DEFINITION

3. To administer oxygen. To remove secretions. To promote airway patency. To assist when the patient has difficulty in breathing. To administer anesthetics. Purposes

4. Inability to maintain tone of the airway in conditions such as - trauma of the face and neck with oropharyngeal bleeding. - edema of upper airway secondary to anaphylaxis. Inability to have spontaneous ventilation despite prolonged respiratory effort in case of COPD Status asthmatics Indications

5. Poor oxygenation. ARDs Pneumonia Carbon monoxide toxicity Cyanide toxicity Clinically deteriorating conditions CNS depression Neuromuscular disease Septic shock

6. Complete obstruction of upper airway in which surgical airway is only remedy. Cervical spine injury Contraindications

7. A wide variety of endotracheal tubes are used either oro -tracheal or naso -tracheal intubations. Some of them are having cuffs while others don’t. Oro-tracheal tubes arev larger than naso tubes. Size is maked in mm on outer side of tube. Endotracheal tubes

8. New born 2.5mm – 4mm 0-1 years 4mm – 4.5mm Upto 10 yrs 5mm- 7mm Above 10 yrs 7mm – 8mm Adults 8mm – 9.5mm Sizes of et tubes

9. Check the patient’s name and other identification data. Check the vital signs Asses the level of consciousness Asses the anatomy of airway such as ability to open the mouth,presence of dentures and size of tongue. Check the oxygen saturation and ABG results. Findings of x ray chest. Preliminary assessment

10. An intubation tube of appropriate size Endotracheal tube of appropriate size Stylet –a wire Laryngoscope with appropriate striaght /curved blade Oral airway Magill’s forceps Suction catheter Suction apparatus oxygen source and tubing Disposable syringe xiv. Cotton tape Xylocaine jelly xv. scissor Towel xvi. Rolled towel Sterile gloves and mask xvii. Induction agents as per Ambu bag and mask physicians order . Stethoscope Preparation of articles

11. AMBU BAG WITH MASK MAGILLS FORCEP STYLET WIRE

12. Explain the procedure to the patients and family. Assemble and prepare all the equipments needed. Assemble laryngoscope and ensure that light is bright. Place the ET tube in a sterile field. Lubricate the distal end of the tube with xylocaine jelly. Insert the stylet into the ET tube Ensure that all the equipments are in working condition. Asses the loose teeth/dentures/foreign body in throat ;if so remove with magill’s forceps. Position the patient with head and slightly elevated at 10 ;remove the headboard if possible and needed . Place the rolled towel under the neck . Administer premedications (induction agents) as per order. Spray the anesthetic medicine in the throat if needed procedure

13. Apply suction to the oral cavity. Provide laryngoscope to doctor. Hold laryngoscope in the left hand and insert the blade along the right side of the tongue ;with the right thumb and index finger ;pull lower lip away from the patient’s lower teeth. Lift the laryngoscope upwards and forward at 45 . After visualizing the vocal cords ,insert the ET into the right side while continuously visualizing the vocal cards . Insert the tube slowly ,gradually and downward till it reaches beyond the cords. Once it reaches beyond the cords , remove laryngoscope and withdraw stylet , the tube when inserted should have 22 mm marking at the incisor teeth. Confirm the correct position of the tube by BILATERAL CHEST MOVEMENTS AUSCULTATION OF CHEST

14. Attach the ambu bag with the oxygen connection to ET tube and continue the bagging to ventilate. Inflate the cuff with 10 ml of air. Insert the oral airway and apply suctioning if necessary. Secure the tube in place with adhesive tube. Ensure the chest x ray is taken.

15. Never leave the patient alone. Provide a comfortable position. Watch and maintain an open airway. Remove the secretions by effective suctioning. Prevent displacement of tube. Watch for complications such as laryngeal, oedema , tracheal stenosis , heamorrhage . Provide for the humidification of air by boiling a kettle of water in the patient’s unit. Prevent infection introduced into the lungs. Prevent contamination of inhaled air, Maintain oral hygiene. Maintain adequate nutrition of the patient by naso gastric feeding or by giving IV fluids. They should never be fed an oral feeds as long as tube is in the mouth. After care of the patient

16. It includes the following Date and time of intubation. Pre procedure assessment. Et tube type and size. Cuff pressure Condition during and post procedure. Follow up. Documentation

17. LAUGH A LOT. IT CLEARS THE LUNGS …….