Indicated in cardiac arrest, serious head injury, certain acute respiratory and trauma settings, and prior to many surgical operations.
- Effective bag and mask ventilation is better than multiple attempts at endotracheal intubation in the arrest setting.
- Except in a dire emergency endotracheal intubation should not be performed without expert supervision.
- 10mL syringe.
- Endotracheal tube (ET; size 8-9 for females and 9-11 for males).
- Laryngoscope.
- Ribbon to secure tube; lubricating jelly.
Preparation
- Pre-oxygenate the patient.
- Ensure that the laryngoscope and ET cuff are functioning.
- Remove any dentures, and suction excess saliva and secretions.
- Extend the neck.
- Insert the laryngoscope pushing the tongue to the left.
- Advance the scope anterior to the epiglottis and pull gently but firmly upwards to expose the vocal cords. Take care not to lever on the upper teeth with the heel of the scope.
- Insert the lubricated ET tube between the cords into the trachea.
- Confirm correct positioning of the tube by observing chest movements, and listening over lung bases and stomach.
- Progressively inflate the cuff and attach ventilation equipment.
- Confirm correct cuff inflation by listening for whistling or bubbling in the larynx suggesting air leak and secure the tube in place with ribbon.
- Patients not in cardiac arrest or who maintain a gag reflex will need anaesthetizing prior to oropharyngeal intubation, i.e. administration of inducing agent plus muscle relaxant.
- The best setting to learn intubation is preoperatively in the anaesthetic room of a theatre with good supervision in controlled conditions.
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