3 Advantages of tracheal intubations: Airway patencyProtects the airwayMaintains patency during positioningControl of ventilationventilation over a long period of time without intubation can lead to gastric distention and regurgitation
4 Advantages of tracheal intubations: Route for inhalation anesthesia and emergency medicationsN - NarcanA - AtropineL - LidocaineE - Epinephrine
5 Complications of tracheal intubation: Trauma to the lips, teeth, and soft tissues of the airway.Awarenessmeticulous techniqueBronchial intubationfrequent complicationauscultation of the chest bilaterally
6 Complications of tracheal intubations: Laryngospasmcommon when extubation is done when the patient is in a semiconscious stateextubation should be done in a relatively deep anesthesia or when the protective laryngeal reflex has returnedPostintubation hoarseness and sore throatdue to mechanical presence of the tracheal tube
7 Preparation of Equipment Assemble pharyngeal airways in assorted sizesNasopharyngealOropharyngealInspect laryngoscope for serviceabilityBatteriesLight bulbBlades; curved/straight (Macintosh or Miller)
8 Selection of laryngoscope blade (preference) Macintosh is a curved blade whose tip is inserted into the vallecula (the space between the base of the tongue and the pharyngeal surface of the epiglottis). Most adults require a Macintosh number 3 or 4 blade.
9 Selection of laryngoscope blade (preference) Miller is a straight blade that is passed so that the tip of the blade lies beneath the laryngeal surface of the epiglottis. The epiglottis is then lifted to expose the vocal cords. Most adults require a Miller number 3 blade.
10 Preparation of Equipment -Inspect endotracheal tubes Tube sizeadult male 8 mm to 9 mm tubeadult female 7 mm to 8 mm tubeTube length- extend from the lower incisor to a point midway between the cricoid cartilage and Louis's angle (the sternal angle) on the patientEndotracheal tube cuff
11 Preparation of Equipment Malleable stylet (should not extend past Murphy's eye)LubricationLaryngeal sprays
12 Inspect resuscitator (AMBU bag) for serviceability MaskIntake valveValve body with relief valve
14 Gather and prepare all equipment necessary for an emergency Airway Scalpel handleSurgical bladesCurved hemostatsEndotracheal tubeSyringe
15 Intubation Techniqueventilate with 100 percent oxygen for approximately 1 minPosition bed height to bring the patient's head to a mid-abdominal heightFlex the cervical spine and extend the head at the atlanto-occipital jointLong axis of the oral cavity, pharynx, and trachea lie almost in a straight line
16 Intubation Techniqueintroduce the blade into the right side of the patient's mouthmove the blade posteriorly and toward the midline, sweeping the tongue to the left and keeping it away from the visual path with the flange of the bladeensure the lower lip is not being pinched by the lower incisors and laryngoscope bladeadvance the laryngoscope until the epiglottis is in view
17 Intubation Technique lift the laryngoscope upward and forward insert the endotracheal tube from the right with its concave curve facing downward and to the right side of the patientmaneuver the endotracheal tube into the larynx, midway between the cricoid cartilage and the sternal angle
18 Intubation Techniqueinflate the cuff and apply positive pressure ventilation while the assistant auscultatessecure the endotracheal tube in position
19 Curved Blade Technique The curved blade technique is essentially similar. The only difference being when the epiglottis is in view, advance the tip of the laryngoscope blade into the vallecula, formed by the base of the tongue and the epiglottis; lift upward and forward.
20 Nasotracheal intubation technique topical lidocaine or phenylephrine should be applied to the nasal passages% Neosynephrine and 4% Lidocaine, mixed 1:1 should also give satisfactory resultsgenerously lubricate the nares and endotracheal tubeET tube should be advanced through the nose directly backward toward the nasopharynx
21 Nasotracheal intubation technique loss of resistance marks the entrance into the oropharynxlaryngoscope and Magill forceps can be used to guide the endotracheal tube into the trachea under direct visionfor awake spontaneous breathing patients, the blind technique can be used
22 Confirmation of tracheal intubation: Direct visualization of the ET tube passing through the vocal cordsCO2 in exhaled gasesBilateral breath soundsAbsence of air movement during epigastric auscultation
23 Confirmation of tracheal intubation: Condensation (fogging) of water vapor in the tube on exhalationRefilling of reservoir bag during exhalationMaintenance of arterial oxygenationChest X-ray: the tip of the ET tube should be between the carina and thoracic arc or approximately at the level of the aortic arch
24 Extubationensure that the patient is recovering is breathing spontaneously with adequate volumesevaluate the patient's ability to protect his airway by observing whether the patient responds appropriately to verbal commands
25 Extubation steps:Oxygenate patient with 100 percent high flow O2 for 2 to 3 minutesif secretions are suspected in the tracheobronchial tree, remove them with a suction catheter through the lumen of the endotracheal tubeensure that the patient is not in a semiconscious state
26 Extubation steps:turn the patient onto his side if he is still unconsciousunsecure the endotracheal tube from the patient's facedeflate the cuff and remove the endotracheal tube quickly and smoothly during inspirationcontinue to give the patient O2 as required