Intubation

EQUIPMENT

  • IV access
  • Pulse oximetry monitor
  • Yankauer with suction apparatus
  • Laryngoscope handle with multiple blades
  • Endotracheal tubes (ETT) with stylet and syringe:Children: (Age + 4)/4Female: 7.0-7.5Male: 7.5-8.0
  • Bag valve mask (BVM)
  • Non-rebreather mask
  • Oxygen
  • CO2 detector
  • LMA/Combitube
  • Tube lock apparatus or tape
  • Sedative Agent
  • Paralytic Agent

PROCEDURE

  • Patient should be sedated and then paralyzed before the procedure.
  • Assess airway: Remove dentures, assess for signs of difficult intubation (LEMON Assessment)
  • Preoxygenate with non-rebreather or bag-valve-mask.
  • Position at patient’s head
  • Position the patient into “sniffing position” if possible. Trauma patients are collared and patient cannot be placed in the sniffing position.
  • Open airway: open the mouth with thumb and forefinger to unlock the lower jaw
  • Insert laryngoscope blade with left hand in the right side of the mouth. The Macintosh should be inserted in front of the epiglottis in the epiglottic vellecula and the Miller behind the epiglottis. Pull up and out at 45 degree angle.
  • Visualize vocal cords, if you cannot, ask for assistance with procedures like the BURP or Sellick maneuver
  • Advance ETT with right hand through cords.
  • Remove stylet.
  • Inflate ETT cuff with 10 cc air via syringe.
  • Ventilate with bag and oxygen.
  • Confirm tube placement with chest auscultation, CO2 monitor and chest x-ray.
  • Secure tube with Tube Lock Device or tape

PROCEDURE NOTE

Date:

Indication:

Resident:

Attending:

A time-out was completed verifying correct patient, procedure, site, positioning.Patient was evaluated and required intubation for above reason.Sedative agent used: EtomidateParalysis agent used: Succinylcholine The patient was prepared in the appropriate fashion and a 7.5(?)8.0 French endotrachial tube was placed under direct visualization to 22(?)24 cm at the lip and balloon was inflated with 10mL of air. Bilateral breath sounds were heard without air sounds in the abdomen. An end-tital Co2 monitor was used to confirm tracheal placement of the ET tube. Patient tolerated the procedure well and there were no complications.Chest xray was(?)was not ordered to assess for pneumothorax and endotracheal tube placement.