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

 

  1. 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

 

  1. 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