Lund Center for Emergency Medicine
Lund, Sweden
info@lucem.info

Intubation

Clarity in Emergency Medicine

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