ET intubation( Endotracheal Intubation)

It is one of the emergency mechanical ventilation for life-threatening conditions

1. EN D OTRA C H EAL INTUBATION

2. DEFINITION Endo tracheal intubation is the placement of a flexible plastic tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs.

3. PURPOSE  To administer oxygen  To remove secretions  To ventilate the lungs.  To establish and maintain airway  To treat acute respiratory failure and persistent hypoxemia.

4. IN D I CAT I ONS  CNS Depression.  Neuromuscular disease.  Chest wall injury.  Upper airway obstruction.  Aspiration prophylaxis.  Fracture vertebrae and spinal cord .

5. ARTICLES REQUIRED  Sand Bag /Towel roll  Suction apparatus with Tubing  Suction Catheter  Ambu bag and Mask  Oxygen source and Tubing  Laryngoscope with appropriate size blade  Magill’s Forceps

6. C ont . .  Endo tracheal tube of appropriate size  Stylette  Xylocaine jelly  Plastic syringe 10ml  Oral airway  Cotton Tape  Gloves  Face mask

7. Different sizes of cuffed and plain ET Tubes

8. LARYNGEOSCOPE

9. MAGILL’S FORCEPS

10. SYRINGE TO INFLATE CUFF

11. SUCTION APPARATUS

12. Technique of Intubation  Raise the head by 5 cm with a block or towel roll

13. P O SITI O N F O R INTUBATION Position your patient in supine position with head extended by keeping sand bag or towel role under the neck.

14. PROCEDURE Hold the laryngoscope with LEFT hand irrespective of dominant hand Open the mouth with right hand index finger with support of thumb. Introduce Laryngoscope from right angle of mouth Shift the tongue to left and go in. Press over tongue. See epiglottis and lift it. Watch for vocal cord

15. Procedure cont..

16. P r o c e d u re c o n t..

17. C ont…  Take the tube in right hand  Introduce under vision  Confirm placement by auscultation  If tube is cuffed inflate the cuff

18. C ont . .  Connect the source to tube  Confirm the position of tube by auscultation by chest expansion by bag movement  Fix the tube with adhesive.

19. Stabilizing ET Tube

20. C ont . .  Connection to ventilate with -ambu's bag -anesthesia machine -ventilator

21. ENDO TRACHEAL TUBE IN PLACE

22. POST PROCEDURE CARE  Place the patient in lateral position  Arrange for chest X-ray in order to check placement of ET Tube  Apply endotracheal suctioning as needed.  Watch for chest movements,ET Tube kinking, obstruction,leakage of tube cuff and over inflation of cuff

23. COMPLICATIONS  Tube in esophagus  Endo bronchial Intubation  Trauma to lips and tooth  Laryngeal and tracheal Injury  Baro trauma to lungs  Bleeding  Tracheities  Pulmonary infection and sepsis