1. Optional, AEMT

2. Course Objectives Describe Sellick’s maneuver and the use of cricoid pressure during intubation. Describe the necessary equipment needed to perform orotracheal intubation. Describe the indications, advantages, disadvantages, and complications of orotracheal intubation. Describe the visual landmarks for direct laryngoscopy.

3. Course Objectives Describe steps to perform orotracheal intubation. Describe the methods of assessing, confirming, and securing correct placement of an orotracheal tube. Describe the technique for extubation.

4. Sellick’s Maneuver Helps prevent regurgitation and reduces gastric distention. Locate the cricoid cartilage by palpating the thyroid cartilage and the feel the depression just below it (cricothyroid membrane). Using your thumb and index finger of one hand, apply pressure to the anterior and lateral aspects of the cricoid cartilage just next to the midline. See picture on next slide.

5. Sellick’s Maneuver

6. Airway Before Applying Sellick’s

7. Airway with Sellick’s Applied (Note compression on the esophagus.)

8. Oraltracheal Intubation Equipment Laryngoscope handle and blade Endotracheal tube 10 ml syringe Stylet BVM Suction device Bite block Magill forceps Tape or tube-holding device

9. Laryngoscope Blades

10. Engaging Laryngoscope Blade and Handle

11. Activating Laryngoscope Light Source

12. Placement of Macintosh Blade into Vallecula

13. Placement of Miller Blade under Epiglottis

14. Endotracheal Tube 5.0 mm-9.0 mm (cuffed) Distal end has a beveled tip for smooth movement through airway passages. Length ranges from 12cm- 32cm. Typical size for an average adult male is 7.5-8.5 mm Typical size for an average adult female is 7.0-8.0 mm

15. Tube and Syringe

16. Tube, Stylet, and Syringe, Unassembled

17. Tube, Stylet, and Syringe, Assembled for Intubation

18. Magill Foreceps

19. Tube-Holding Device

20. Oraltracheal Intubation Indicators Respiratory or cardiac arrest Unconsciousness Risk of aspiration Obstruction due to foreign bodies, trauma, burns, or anaphylaxis Respiratory extremis due to disease Pneumothorax, hemothorax, hemopneumothorax with respiratory difficulty

21. Advantages of Oraltracheal Intubation Isolates trachea and permits complete control of airway Impedes gastric distention Eliminates need to maintain a mask seal Offers direct route for suctioning Permits administration of some medications

22. Disadvantages of Endotracheal Intubation Requires considerable training and experience Requires specialized equipment Requires direct visualization of vocal cords Bypasses upper airway’s functions of warming, filtering, and humidifying the inhaled air

23. Complications of Oraltracheal Intubation Equipment malfunction Teeth breakage and soft tissue lacerations Hypoxia Esophageal intubation Endobronchial intubation Tension pneumothorax

24. Visual Landmarks

25. Hyperventilate the patient

26. Prepare and Test Equipment

27. Apply Sellick’s maneuver and insert laryngoscope

28. Visualize glottis through laryngoscopy

29. Inflate cuff, ventilate, and auscultate

30. Confirm placement with an ETCO 2 detector

31. Secure tube

32. Reconfirm tube placement

33. Field Extubation Prepare intubation equipment and suction Confirm patient responsiveness Suction the patient’s oropharynx Deflate the cuff Remove the tube upon cough or expiration Provide supplemental oxygen as needed Reassess the adequacy of the patient’s ventilation and oxygenation

34. Summary Sellick’s manuever Necessary equipment to perform orotracheal intubation Indications, advantages, disadvantages, and complications of orotracheal intubation Visual landmarks Steps to perform orotracheal intubation Methods of assessing, confirming, and securing correct placement of an orotracheal tube Technique for extubation