Orotracheal Intubation: Basic Technique

PRE-PROCEDURE

 

INDICATIONS   Failure to oxygenate adequately. Failure to ventilate adequately. Failure of or need for airway maintenance or protection. Expected need for intubation based on progression of underlying physiologic process.   CONTRAINDICATIONS   Do Not Resuscitate (DNR)/Do Not Intubate (DNI) orders Partial tracheal transection Difficult airway (relative)   EQUIPMENT   Equipment for universal precautions (mask, gloves, etc.) **UNIVERSAL PRECAUTIONS** Standard direct laryngoscope Laryngoscope blades Laryngoscope handle with batteries Endotracheal tubes (ETTs) and accessories Endotracheal tubes, variable sizes Malleable ETT stylet 10-mL syringe ETT tape or commercial ETT holder Basic airway equipment Bag and mask ventilation device Oropharyngeal and/or nasopharyngeal airways Oxygen source and tubing Sedative and neuromuscular blocking agents Water-based lubricant (i.e., Surgilube) Yankauer suction catheter and tubing General resuscitation equipment Peripheral IV (in place) Cardiac monitor Oxygen saturation probe Blood pressure cuff End-tidal CO2 detector Rescue devices Laryngeal mask airway or laryngeal tube Intubating stylet (Frova or bougie) Ventilator   ANATOMY   Oral cavity and oropharynx During laryngoscopy, the blade slides along the right side of the tongue in the perilingual gutter. The tongue is move leftward and upward into the floor of the mouth and mandibular fossa to expose the larynx. Larynx. The small space between the epiglottis and base of the tongue is the vallecula. Curved laryngoscope blades are designed to be placed in this recess. Straight blades should be placed posterior to the epiglottis. Trachea The tip of a correctly positioned ETT should rest midway between the inferior border of the cricoid ring and the trachea. The average tracheal diameter is 10 to 12 mm and can accommodate an 8.0 ETT.

Figure 1 :  Orotracheal intubation. View Larger Image Figure 8 :  Macintosh blade. View Larger Image Figure 9 :  Miller blade. View Larger Image Figure 13 :  Laryngeal anatomy, as seen during orotracheal intubation. View Larger Image

PROCEDURE

 

Sample excerpt does not include step-by-step text instructions for performing this procedure Sign up for a FREE TRIAL to view full content The full content of this section includes: Step-by-step text instructions for performing the procedure Clinical pearls providing practical clinical tips from medical experts Patient safety guidelines consistent with Joint Commission and OHSA standards Links to medical evidence and related procedures

Figure 15 :  Place the patient into the sniffing position and preoxygenate. View Larger Image Figure 17 :  Hold the laryngoscope with your left hand, and use your right hand to open the mouth. View Larger Image Figure 18 :  Displace the tongue to the left. View Larger Image Figure 20 :  Direct the force along the axis of the laryngoscope blade. View Larger Image Figure 21 :  Insert the ETT into the right side of the mouth, along the laryngoscope blade. View Larger Image

POST-PROCEDURE

 

CARE   Confirm tube placement. Secure the tube. Obtain a chest radiograph. Insert a nasogastric or orogastric tube. Provide sedation and pain control. Obtain an arterial blood gas analysis.   COMPLICATIONS   Unrecognized esophageal intubation Main-stem bronchus intubation Dental, pharyngeal, and airway trauma

Figure 25 :  Obtain a post-intubation chest radiograph. View Larger Image

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