Alternative Airways: Endotracheal Tubes And Laryngeal Masks (Lesson 5)

Question 1

What size laryngoscope blade would you use for a term newborn? A preterm newborn? A very preterm newborn?

Answer 1

No. 1 for term newborn. No. 0 for a preterm newborn. No. 00 for very preterm newborn

Question 2

What size endotracheal tube should you use for a baby weighing less than 1000 grams and below 28 weeks gestational age? For a baby 1000 to 2000 g and 28 to 34 weeks gestational age? For baby weighing greater than 2000 g and greater than 34 weeks gestational age?

Answer 2

2.5, 3.0, 3.5

Question 3

How much time should be allowed for intubation attempt?

Answer 3

30 seconds

Question 4

How deeply should the endotracheal tube be inserted within the trachea? (tip to lip)

Answer 4

NTL + 1 cm (nasal septum to ear tragus length) OR tip to lip depth based on gestational age (see chart)

Question 5

On chest x-ray, the tip of the tracheal tube should appear in the mid trachea adjacent to what structure?

Answer 5

Adjacent to the first or second thoracic vertebrae. (The tip should be above the carina, which is generally adjacent to the third or fourth thoracic vertebra)

Question 6

What problems would you consider if a baby’s condition worsens after endotracheal intubation?

Answer 6

DOPE mnemonic. Displaced endotracheal tube. Obstructed endotracheal tube. Pneumothorax. Equipment failure.

Question 7

What are the indications for endotracheal intubation during resuscitation?

Answer 7

Should be considered if:
If PPV with a face mask does not result in clinical improvement. Or if PPV lasts for more than a few minutes.

Strongly recommended if:
If chest compressions are required.
Reliable airway access in the setting of (1) stabilization of newborn with suspected diaphragmatic hernia (2) surfactant administration and (3) direct tracheal suction if airway obstructed by thick secretions

Question 8

What indicators determine correct placement of the endotracheal tube?

Answer 8

The primary methods of confirming endotracheal tube placement within the trachea are detecting exhaled CO2 and a rapidly rising heart rate. You should also observe audible and equal breath sounds near both axilla during positive pressure ventilation, symmetrical chest movement with each breast, little or no air leak from the mouth during positive pressure ventilation, and decreased or absent air entry over the stomach.