Routine INTUBATION
objectives
▪ To recognize the symptoms for endotracheal intubation
▪ To have the ability put together for and perform safe endotracheal intubation
▪ so one can pick out the affected person who's probably to be a "tough intubation"
▪ with the intention to put together a tough Intubation Tray
▪ To have a methodical approach to the control of a "difficult intubation"
▪ To recognise and be able to perform the variety of available alternatives within the management of the "hard intubation"
● The "BURP" method (see later)
● The laryngeal mask
● Airway Bougie insertion
● Needle Cricothyroidotomy
● Cricothyroidotomy - open technique
- Seldinger technique
▪ To know the blessings, risks, and complications of each of the above strategies.
symptoms FOR INTUBATION
▪ To maintain airway patency
▪ To preserve airway protection (GCS 8 or much less)
▪ Hypoxia / hypercarbia (breathing failure)
▪ Provision of remedy eg hyperventilation in head damage (controversial)
▪ research eg CT scan without movement artefact
coaching FOR ENDOTRACHEAL INTUBATION
1. The personnel
● bring together the most experienced staff available
● an appropriate wide variety of personnel required is 3
¤ the person intubating
¤ the individual assigned to manage the medicines and deliver the requested gadget
¤ the person assigned to provide cricoid pressure (or thyroid "BURP" strain if hard intubation is expected)
● A fourth workforce member can be needed to perform in line stabilization of the cervical spine if there's a opportunity of damage.
● Allocate and demonstrate how to carry out these precise tasks before starting up the technique so that all are clear as to their role.
2. The system
● Have a everyday protocol mounted wherein all device required for the technique is checked on the start of every shift as being present and functional.
● where time permits, recheck all device before commencing.
● make certain :
¤ laryngoscope is present and operating. Have a size 3 and length 4 laryngoscope blade to be had for adults.
¤ the appropriate sized oropharyngeal airway is available
¤ the bag valve masks is useful and is connected to oxygen and has the ideal sized face masks outfitted
¤ the ideal sized endotracheal tube is gift and, if it's miles cuffed, that the cuff does now not leak. Tube sizes are commonly :
adult male length 8-9mm adult girl size 7-7.5mm
child 4mm + age/four (uncuffed as much as age of 8 years)
¤ a lubricated introducer is positioned inside the endotracheal tube
¤ the Yankeur suction is running
¤ all medicinal drugs are equipped and available in suitable doses
¤ have the "crash trolley" and hard Intubation Tray geared up
three. The patient
● cozy IV get entry to and flush cannula to make certain patency
● wherein possible ensure the affected person is fasted 4-6 hours (this isn't always generally possible inside the emergency putting)
● If the want for intubation is not instant, treat or exclude comorbid conditions which may be exacerbated with the aid of intubation eg pneumothorax, hypovolaemia
● role the patient supine with the top extended and the neck flexed. this may be facilitated by using a skinny pillow being located below the pinnacle. This
position will not best preserve an open airway to useful resource bag valve air flow, but may also aid intubation.
● Cervical backbone precautions need to be discovered wherein there is a probability of cervical spine injury. (use in line stabilization ie someone is allotted to squat beside the intubator and preserve the affected person's head at the perimeters without making use of traction and stopping motion as plenty as possible during intubation)
● Preoxygenate with 100% oxygen for 5 mins. that is normally finished using a bag valve masks connected to oxygen. If the affected person is respiration spontaneously guide air flow isn't always vital and might chance gastric distension and regugitation/aspiration.
● monitor : SaO2, ECG, BP
▪ To recognize the symptoms for endotracheal intubation
▪ To have the ability put together for and perform safe endotracheal intubation
▪ so one can pick out the affected person who's probably to be a "tough intubation"
▪ with the intention to put together a tough Intubation Tray
▪ To have a methodical approach to the control of a "difficult intubation"
▪ To recognise and be able to perform the variety of available alternatives within the management of the "hard intubation"
● The "BURP" method (see later)
● The laryngeal mask
● Airway Bougie insertion
● Needle Cricothyroidotomy
● Cricothyroidotomy - open technique
- Seldinger technique
▪ To know the blessings, risks, and complications of each of the above strategies.
symptoms FOR INTUBATION
▪ To maintain airway patency
▪ To preserve airway protection (GCS 8 or much less)
▪ Hypoxia / hypercarbia (breathing failure)
▪ Provision of remedy eg hyperventilation in head damage (controversial)
▪ research eg CT scan without movement artefact
coaching FOR ENDOTRACHEAL INTUBATION
1. The personnel
● bring together the most experienced staff available
● an appropriate wide variety of personnel required is 3
¤ the person intubating
¤ the individual assigned to manage the medicines and deliver the requested gadget
¤ the person assigned to provide cricoid pressure (or thyroid "BURP" strain if hard intubation is expected)
● A fourth workforce member can be needed to perform in line stabilization of the cervical spine if there's a opportunity of damage.
● Allocate and demonstrate how to carry out these precise tasks before starting up the technique so that all are clear as to their role.
2. The system
● Have a everyday protocol mounted wherein all device required for the technique is checked on the start of every shift as being present and functional.
● where time permits, recheck all device before commencing.
● make certain :
¤ laryngoscope is present and operating. Have a size 3 and length 4 laryngoscope blade to be had for adults.
¤ the appropriate sized oropharyngeal airway is available
¤ the bag valve masks is useful and is connected to oxygen and has the ideal sized face masks outfitted
¤ the ideal sized endotracheal tube is gift and, if it's miles cuffed, that the cuff does now not leak. Tube sizes are commonly :
adult male length 8-9mm adult girl size 7-7.5mm
child 4mm + age/four (uncuffed as much as age of 8 years)
¤ a lubricated introducer is positioned inside the endotracheal tube
¤ the Yankeur suction is running
¤ all medicinal drugs are equipped and available in suitable doses
¤ have the "crash trolley" and hard Intubation Tray geared up
three. The patient
● cozy IV get entry to and flush cannula to make certain patency
● wherein possible ensure the affected person is fasted 4-6 hours (this isn't always generally possible inside the emergency putting)
● If the want for intubation is not instant, treat or exclude comorbid conditions which may be exacerbated with the aid of intubation eg pneumothorax, hypovolaemia
● role the patient supine with the top extended and the neck flexed. this may be facilitated by using a skinny pillow being located below the pinnacle. This
position will not best preserve an open airway to useful resource bag valve air flow, but may also aid intubation.
● Cervical backbone precautions need to be discovered wherein there is a probability of cervical spine injury. (use in line stabilization ie someone is allotted to squat beside the intubator and preserve the affected person's head at the perimeters without making use of traction and stopping motion as plenty as possible during intubation)
● Preoxygenate with 100% oxygen for 5 mins. that is normally finished using a bag valve masks connected to oxygen. If the affected person is respiration spontaneously guide air flow isn't always vital and might chance gastric distension and regugitation/aspiration.
● monitor : SaO2, ECG, BP
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