Intubation

ENDOTRACHEAL INTUBATION

Indications

• Inadequate oxygenation or ventilation through less invasive means

• Risk for aspiration (endotracheal intubation gold standard to secure the airway)

• Upper airway obstruction

• Clinical course where airway intervention is likely to be required

Contraindication

• Partial transection of the trachea

1. Prior

Prepare the patient

• A: Optimize the height of the gurney and the patient’s head position

• B: on-going pulse oximetry, preoxygenation

• C: IV access x 2, crystalloid infusion, 3 lead EKG, blood pressure monitoring

• D: Gross neurological examination prior to sedation and paralysis

Prepare the equipment

• Medications: draw up the medications, label the syringes

• Laryngoscope: correctly sized blade, check the lamp

• Suction: activated, within reach

• Endotracheal tube: estimated required size + other sizes available, check the cuff

• Stylet and/or bougie

• Capnometer and stethoscope

• Bag-valve-mask

• Equipment to fixate the tube

• Plan B equipment, e.g. laryngeal mask airway of correct size

2. Procedure

• Administer medications as indicated

• Optimize head position

• Insert the laryngoscope, lift along its axis to visualize the vocal cords, additional maneuvers (e.g. BURP) as needed

• Insert the endotracheal tube to the correct depth, cuff, remove the stylet

3. Post

• Ventilate with the bag, assess chest wall motion

• Connect the capnometer, assess EtCO₂ during 6 breaths

• Insert an OPA or bite block

• Secure the tube

• Register tube depth

• Plan for continued sedation

• Order a chest X-ray or corresponding investigation