Orotracheal Intubat 0
orotracheal intubation
indications
1. inadequate oxygenation (decreased arterial po2, etc.) that is not corrected by supplemental oxygen supplied by mask or nasal prongs.
2. inadequate ventilation (increased arterial pco2).
3. need to control and remove pulmonary secretions (bronchial toilet).
4. need to provide airway protection in an obtunded patient or a patient with a depressed gag reflex (for example during a general anesthesia).
contraindications
the following are only relative contraindications to tracheal intubation:
1. severe airway trauma or obstruction that does not permit safe passage of an endotracheal tube. emergency cricothyrotomy is indicated in such cases.
2. cervical spine injury, in which the need for complete immobilization of the cervical spine makes endotracheal intubation difficult.
preparing the procedure
when intubating a patient, there are certain bare essentials that must be present to ensure a safe intubation. they can be remembered by the mnemonic salt
suction. this is extremely important. often patients will have material in the pharynx, making visualization of the vocal cords difficult. pulmonary aspiration should be avoided. airway. the oral airway is a device that lifts the tongue off the posterior pharynx, often making it easier to mask ventilate a patient. the inability to ventilate a patient is bad. also a source of o2 with a delivery mechanism (ambu-bag and mask) must be available.
laryngoscope. this lighted tool is vital to placing an endotracheal tube.
tube. endotracheal tubes come in many sizes. in the average adult a size 7.0 or 8.0 oral endotracheal tube will work just fine.
equipment required
1. self-refilling bag-valve combination (eg, ambu bag) or bag-valve unit (ayres bag), connector, tubing, and oxygen source. assemble all items before attempting intubation.
2. laryngoscope with curved (macintosh type) and straight (miller type) blades of a size appropriate for the patient.
3. endotracheal tubes of several different sizes. low-pressure, high-flow cuffed balloons are preferred.
4. oral airways.
5. tincture of benzoin and precut tape.
6. introducer (stylets or magill forceps).
7. suction apparatus (tonsil tip and catheter suction).
8. syringe, 10-ml, to inflate the cuff.
9. mucosal anesthetics (eg, 2% lidocaine)
10. water-soluble sterile lubricant.
11. gloves.
position of the patient
the height of the table where the patient is lied, should be adjusted so that the patient's face is at the level of the xiphoid cartilage of the standing person who is performing the procedure. elevating the patient's head about 10 cm with pads under the occiput and extension of the head at the atlanto-occipital joint (sniffing position) serve to align the oral, pharyngeal, and laryngeal axis, so that the passage from the lips to the glottic opening is almost a straight line. this position permits better visualization of the glottis and vocal cords and allows easier passage of the endotracheal tube. for children under 1 month of age, the head should be in a neutral position. see figure 1.
orotracheal intubation
indications
1. inadequate oxygenation (decreased arterial po2, etc.) that is not corrected by supplemental oxygen supplied by mask or nasal prongs.
2. inadequate ventilation (increased arterial pco2).
3. need to control and remove pulmonary secretions (bronchial toilet).
4. need to provide airway protection in an obtunded patient or a patient with a depressed gag reflex (for example during a general anesthesia).
contraindications
the following are only relative contraindications to tracheal intubation:
1. severe airway trauma or obstruction that does not permit safe passage of an endotracheal tube. emergency cricothyrotomy is indicated in such cases.
2. cervical spine injury, in which the need for complete immobilization of the cervical spine makes endotracheal intubation difficult.
preparing the procedure
when intubating a patient, there are certain bare essentials that must be present to ensure a safe intubation. they can be remembered by the mnemonic salt
suction. this is extremely important. often patients will have material in the pharynx, making visualization of the vocal cords difficult. pulmonary aspiration should be avoided. airway. the oral airway is a device that lifts the tongue off the posterior pharynx, often making it easier to mask ventilate a patient. the inability to ventilate a patient is bad. also a source of o2 with a delivery mechanism (ambu-bag and mask) must be available.
laryngoscope. this lighted tool is vital to placing an endotracheal tube.
tube. endotracheal tubes come in many sizes. in the average adult a size 7.0 or 8.0 oral endotracheal tube will work just fine.
equipment required
1. self-refilling bag-valve combination (eg, ambu bag) or bag-valve unit (ayres bag), connector, tubing, and oxygen source. assemble all items before attempting intubation.
2. laryngoscope with curved (macintosh type) and straight (miller type) blades of a size appropriate for the patient.
3. endotracheal tubes of several different sizes. low-pressure, high-flow cuffed balloons are preferred.
4. oral airways.
5. tincture of benzoin and precut tape.
6. introducer (stylets or magill forceps).
7. suction apparatus (tonsil tip and catheter suction).
8. syringe, 10-ml, to inflate the cuff.
9. mucosal anesthetics (eg, 2% lidocaine)
10. water-soluble sterile lubricant.
11. gloves.
position of the patient
the height of the table where the patient is lied, should be adjusted so that the patient's face is at the level of the xiphoid cartilage of the standing person who is performing the procedure. elevating the patient's head about 10 cm with pads under the occiput and extension of the head at the atlanto-occipital joint (sniffing position) serve to align the oral, pharyngeal, and laryngeal axis, so that the passage from the lips to the glottic opening is almost a straight line. this position permits better visualization of the glottis and vocal cords and allows easier passage of the endotracheal tube. for children under 1 month of age, the head should be in a neutral position. see figure 1.