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Basic Airway Management & Endotracheal Intubation

(Note: Rapid sequence and use of pharmacologic adjuncts for intubation are not specifically covered in this section)

Indications:

1.       Treatment of symptomatic hypercapnia.

2.       Treatment of symptomatic hypoxemia.

3.       Airway protection against aspiration.                                   

4.       Pulmonary toilet.                

Contraindications:

1.       Awake patient.

2.       Airway can be managed less invasively.

Equipment:

1.       IV access, EKG, pulse ox monitors.

2.       Suction apparatus.

3.       Oropharyngeal, nasopharyngeal airways.

4.       Non- rebreather mask.

5.       Oxygen.

6.       Bag valve mask.

7.       Appropriate size endotracheal tube (7.5 mm – adult, child = diameter of little finger); with stylet and 10cc syringe.

8.       Laryngoscope blade and handle (appropriate size).

9.       Tape.

 

Endotracheal tube and laryngoscope sizes:                                                                                      

Age:

Preemie

Neonate

6 mo.

1-2 yr.

4-6 yr.

8-12 yr.

Adult

Tube size:

2.5

3-3.5

3.5-4

4-5

5-5.5

6-7

7.5-8.5

Blade size:

0

0-1

1

1-2

2

2-3

4-5

Procedure:

                                                                                                                                                                                               

 

 

 

 

 

 

 

Complications: Prevention and Management

 

Complication:

Prevention:

Management:

Missing/broken teeth:

Remove loose teeth prior; avoid using upper teeth as fulcrum for laryngoscope blade.

Check chest x-ray to rule out aspiration.

Clenched teeth:

 

Paralytic medication.

 

Air leak:

Check cuff prior to beginning procedure.

Inject more air or change tube over guide wire.

Inability to visualize vocal cords:

Proper patient positioning, proper laryngoscope blade size, proper suctioning.

Reposition, choose a different blade, adequate suction, cricoid pressure by assistant.

Esophageal intubation:

Visualize cords.

Remove tube, re-oxygenate and reinsert.

Right lung intubation:

Avoid excessive tube advancement.

Deflate cuff, re-position and re-inflate.

Laryngospasm:

Spray vocal cords with 2% Lidocaine.

Benzodiazepine or paralytic medication.

Failure to intubate:

None.

Have alternative plan prepared: e.g., BVM, another type of tube, cricothyrotomy.

 

 

Documentation:

Procedure note describes indications, equipment and technique, number of attempts and how placement was confirmed, as well as complications and their management.

 

Items for Evaluation: