Chapter 3: Tracheal Intubation Flashcards
What are the indications for tracheal intubation?
- Acute respiratory failure
- Inadequate oxygenation
- Airway protection in a patient with altered mental status
What are some of the clinical circumstances for the placement of endotracheal tubes?
- Patients receiving general anesthesia
- Surgery involving or adjacent to the airway
- Unconscious patients requiring airway protection
- Surgery involving unusual positioning
What is an absolute contraindication in the placement of an endotracheal tube?
Supraglottic or glottic pathology that precludes placement of an endotracheal tube through the glottis.
What are relative contraindications for the placement of endotracheal tubes?
- Involve potential difficulties performing the procedure
- Anatomically features
- Injuries
- Or illness
Where does the epiglottis lay?
At the base of the tongue
What is the essential landmark for direct laryngoscopy?
The epiglottis
What is the vallecula?
The cleft between the base of the tongue and the epiglottis into which a curved laryngoscope blade is placed
What are the essential preparations for direct laryngoscopy and tracheal intubation?
- Assess the patients airway for difficulty
- Pre-oxygenate
- Place a functioning suction device & bag-valve mask at the bedside
- Attach monitors: b.p., pulse ox. , cardiac
- Establish intravenous access
- Prepare all necessary medications for rapid sequence intubation, induction agent and neuromuscular blocking agent
What tools are needed to perform laryngoscopy?
- Laryngoscope handle and blade
- Endotracheal tubes and a stylet
- Bougie
- Oral and nasal airways
- Laryngeal mask airway
- End-tidal CO2 monitor
- Tape
How do you check the cuff of the endotracheal tube?
By inflating it and removing the syringe (the cuff should remain inflated) and then deflating it.
Tools and steps for tracheal intubation acronym.
S: suction T: Tools for intubation O: Oxygen P: Positioning M: Monitors A: assistant I: Intravenous access D: Drugs for pretreatment
What is the purpose of a laryngoscope?
To displace the mandible, tongue, epiglottis, and any other soft tissue out of the line of sight to expose the glottic opening
What is the curved laryngoscope called?
The Macintosh
What is the straight laryngoscope called?
The Miller.
What is the critical step of direct laryngoscopy?
Locate the epiglottis
What are the best ways to improve a limited laryngeal view?
- increase elevation of the patients head
- Perform bimanual laryngoscopy by manipulating the epiglottis with the laryngoscope and the glottis with the right hand
When should head elevations and cervical spine flex ion not be performed?
Where cervical spine immobilization is necessary.
What is moved during a bimanual laryngoscopy?
It involves moving the thyroid cartilage NOT the cricoid with the right hand
What are the basic steps for performing direct laryngoscopy?
- Obtain assistance
- Prepare equipment, monitors, medications
- Assess, pre-oxygenate, and position the patient
- Open the patients mouth and position the scope
- Deflect the tongue & Locate the epiglottis
- Head elevate and neck flexion
- Insert the tracheal tube
- Confirm using CO2 detectors
- Secure, set parameters, provide sedation
How do you position the patient for direct laryngoscopy with no cervical spine injury.
Elevation of the patients head by approx. 5-7 cm
What is the most effective method for opening the mouth for direct laryngoscopy?
The scissor method. Hold the tips of the thumb and the middle finger of the right hand together, insert them between the upper and lower incisors, and scissor them past one another by flexing each digit.
What side of the mouth should the tongue be contained?
Left side
When do you remove the stylet in the tracheal tube?
Once the tip of the endotracheal tube has passed the vocal cords
When do you stop laryngoscopy and perform bag-mask ventilation?
When patients SpO2 falls bellow 90%
When do you use a tracheal tube inducer ( bougie)?
It’s an adjunct to direct laryngoscopy and difficult airway management. When the view of the epiglottis is limited, and the tracheal tube can be inserted over it.
How do you confirm endotracheal tube placement?
- End-tidal carbon dioxide
2. Clinical findings- listen for equal breath sounds
What is the most accurate means of confirming proper endotracheal tube placement?
End-tidal carbon dioxide determination
What complications are associated with mainstem bronchus intubation?
- Hypoxia
- Hypercapnia
- Pneumothorax
What depth should an endotracheal tube be inserted in a woman and in a man?
- Woman: 20-21 cm
2. Men: 22-23 cm
What is the benchmark for insertion depth?
Teeth or gums
What are some complications that may occur with laryngoscopy?
- direct or blunt penetrating tray,a to the oropharynx, larynx, and tracheal
- Vocal cord injury or dislocation of the arytenoid cartilages.
- Dislocation of the temporomandibular joint
