AIRWAY MANAGEMENT

ENDOTRACAEL INTUBATION

PRACTICAL SESSION ONE

 

  1. Discuss the indications for Endotrachael intubations
    1. Respiratory or cardiac arrest
    2. Unconscious or obtrusion without gag reflex
    3. Risk of aspiration
    4. Obstruction due to FBO, trauma, burns or anaphylaxis
    5. Respiratory extremis due to disease
    6. Pneumothorax or hemothorax

 

  1. Discuss the advantages of Endotrachael intubations
    1. Isolates the trachea and permits complete control of airway
    2. Impedes gastric distention by channeling air directly into the trachea
    3. No need for a mask seal
    4. Offers direct route for suctioning of the respiratory passages
    5. Permits medication administration (LEAN)

 

  1. Discuss the disadvantages of Endotrachael intubations
    1. Technique requires training and experience
    2. Requires specialized equipment
    3. Requires direct visualization of the cords
    4. Bypasses upper airway functions of warming, filtering and humidifying the air

 

  1. Discuss possible complications to Endotrachael intubations
    1. Equipment malfunction – discuss precheck and setup on call
    2. Teeth breakage and soft tissue lacerations
    3. Esophageal intubations (unrecognized)
    4. Endobronchial intubations (right mainstem placement)
    5. Tension Pneumothorax

 

5.     Verification of proper tube placement

a.       Most reliable – direct visualization

b.      Secondary signs:

                                                              i.      Chest rise

                                                            ii.      Breath sounds

                                                          iii.      Lack of epigastric sounds

                                                          iv.      End tidal co2 detection

                                                            v.      Esophageal detector devices

                                                          vi.      Endotrachael tube contents: condensation versus vomitus

 

 

 

 

 

 

6.     Walk through the procedure

a.       Provide ventilitory support while you:

b.      Prepare and check your equipment –includes suction equipment

c.       Position the patient: supine, head in neutral position with slight lift

d.      Hyperventilate the patient for 30 seconds

e.       MONITOR HEART RATE DURING PROCEUDRE

f.       Insert blade, visualize cords

g.      Insert tube/stylet,, retract stylet

h.      Inflate cuff

i.        Verify proper placement

j.        Secure tube

                                                              i.      Demonstrate 3rd party securing device

                                                            ii.      Demonstrate tape

                                                          iii.      Demonstrate tubing

 

Rotate through each student practicing

 

 

 

 

Second session

Additional content

 

Trauma patient intubations

1.     Discuss the need for in-line stabilization

2.     Demonstrate technique for incubating while kneeling with head between knees

3.     demonstrate flat down technique with someone else maintaining stability

 

Have each student practice both techniques

Have each student practice non-trauma technique