Endotracheal Intubation

Summary

Endotracheal intubation is a crucial skill in airway management, best learned through hands-on practice. This guide focuses on the manual techniques necessary for successful intubation, starting with mannequin practice and progressing to patients. Key steps include assessing the airway, positioning the patient, and pre-oxygenation to ensure safety. The procedure involves using a laryngoscope to gain a clear view of the vocal cords, inserting the tube, and verifying placement through CO2 monitoring. Team coordination and patient monitoring are essential throughout, and securing the tube ensures successful ventilation. This video is part of a series on anesthesia and critical care.

Takeaways

• 🫁 Endotracheal intubation is crucial for airway management and is best learned through supervised practice.
• 🩺 Always conduct an airway assessment before intubation to evaluate equipment, personnel, and potential complications.
• 👃 Position the patient in the 'sniffing' position for optimal visibility of the vocal cords during intubation.
• 🌬️ Pre-oxygenate the patient to at least 80% expiratory oxygen concentration or for a minimum of three minutes if monitoring is unavailable.
• 📈 Applying positive end-expiratory pressure (PEEP) and tilting the table can enhance oxygenation, particularly in obese patients.
• 💉 Administer analgesics to reduce pain and airway reflexes, followed by hypnotics and paralytics to facilitate intubation.
• 🫵 Effective manual ventilation techniques, such as the two-finger chin lift or jaw thrust, should be employed if necessary.
• 🔍 During laryngoscopy, carefully use the laryngoscope to push the tongue aside and expose the vocal cords without brute force.
• 🎯 Ensure precise tube insertion and confirm placement using end-tidal CO2 monitoring, avoiding reliance on less accurate signs.
• 🛠️ Secure the tube with tape once its position in the trachea is confirmed, and initiate mechanical ventilation.

Q & A

What is the primary goal of endotracheal intubation?

The primary goal of endotracheal intubation is to establish a secure airway by passing a tube through the vocal cords into the trachea, ensuring the patient can breathe or receive mechanical ventilation.

What are the recommended steps for learning endotracheal intubation?

It is recommended to first practice intubation on a mannequin under expert supervision and then proceed to elective, uncomplicated, and fasted patients for real-world experience.

Why is pre-oxygenation important before intubation, and how can it be optimized?

Pre-oxygenation is crucial as it builds an oxygen reserve in the patient's lungs, buying time during the procedure in case of airway difficulties. It can be optimized by having the patient inhale 100% oxygen or using positive end-expiratory pressure (PEEP), especially in obese patients.

What role does airway assessment play before intubation?

Airway assessment is essential to determine what equipment and personnel are needed, anticipate potential complications, and ensure the entire team is aligned with the intubation plan.

What is the ‘sniffing position’ and why is it important?

The ‘sniffing position’ is when the patient's head is elevated relative to their body by placing a pillow under their shoulders. This position helps achieve a direct line of sight to the vocal cords, making intubation easier.

What equipment is used to visualize the vocal cords during intubation?

A laryngoscope is used to visualize the vocal cords. Traditional direct laryngoscopy is taught, but for recording purposes, a video laryngoscope with the same shape is often used.

What are the key drugs used during intubation, and what are their roles?

Analgesics are used to alleviate pain, while hypnotics induce unconsciousness. A paralytic drug is then administered to facilitate the intubation by relaxing airway muscles and reducing reflexes.

What should be done if face mask ventilation fails during intubation?

If face mask ventilation fails, alternative techniques and equipment should be used. The instructor will demonstrate these techniques in forthcoming videos.

How is successful endotracheal intubation confirmed?

Successful intubation is confirmed by the return of end-tidal carbon dioxide (CO2) over several respiratory cycles. Auscultation, chest wall rise, and condensation in the tube are also signs but should be interpreted cautiously, as they can occur in esophageal intubation.

What is the 'BURP' maneuver, and when is it used during intubation?

The 'BURP' maneuver stands for Backward, Upward, Rightward Pressure on the larynx. It is used to improve the visibility of the vocal cords during laryngoscopy.