Endo-Tracheal Intubation Flashcards
Why do we intubate?
-to maintain airway patency
-to prevent aspiration pneumonia
-to prevent laryngospasm
-to reduce environmental pollution
-to allow IPPV
What equipment is required to intubate?
-suitable sized ET tube
-tube tie
-syringe to inflate cuff
-lubricant
-laryngoscope
-local anaesthetic spray
-assistant
What are the 4 different types of ET tubes?
(Include their volume and pressure)
Red rubber
-low volume, high pressure cuff
PVC
-high volume, low pressure cuff
Silicone
Murphy eye
What steeps are involved in preparation for intubation?
-choose the widest size ET tube that will fit without traumatising airway
-ensure tube is correct length and diameter
-consider use of uncurled tubes in cats
-make sure tube is cleaned
-make sure cuff is operational
-make sure tube is not damaged
What is a laryngoscope?
-used to allow better visualisation of the larynx
-consists of light source and bade
-curved or straight blade
How to use a laryngoscope?
-pull tongue forward
-use blade to depress base of tongue
Describe the intubation process?
-assistant holds the animals head
-ensure anaesthetic depth is adequate
-visualise glottis
-insert tip of bevel then rotate to follow curve of trachea
-use topical local anaesthetic id required
-check placement and secure tube
-inflate cuff if appropriate
How can we check that the tube is correctly placed?
-palpate within the trachea
-auscultate both lung fields
-observe movement in reservoir bag
-check for air movement
-capnograph if available
What complications can intubation cause?
-increased airway resistance if tube is too narrow
-kinking or occlusion of tube
-iatrogenic trauma to larynx or tracheal wall
-irritation to mucosa if tube not rinsed
-over inflation of cuff can cause tracheal damage
-endo bronchial intubation (misplacement)
4 this to help intubate difficult patients?
-patient may be too light
-use lignocaine spray
-anatomical problems use smaller than ideal tube
-pre-oxygenate tricky patients
What are 5 ET tubes problems which can occur?
-ET tube in oesophagus
-ET tube lodged in bronchus
-laryngospasm in cats
-tube blocked or kinked
-tracheal rupture
What signs may indicate the ET tube is in the oesophagus?
-patient doesn’t stay asleep
-low sp02 on pulse oximeter
-low etc02 on capnograph
-no/little movement of reservoir bag
What to do if ET tube is in the oesophagus?
-deflate cuff
-remove ET tube
-re intubate
What signs may indicate the ET tube is lodged in the bronchus?
-sp02 greatly reduced
-unilateral breath sounds
-patient wakes up
What to do if the ET tube is lodged in the bronchus?
-deflate cuff
-gently retract tube slowly and reposition
-re inflate cuff
What to do if laryngospasm in cats is suspected?
-one spray of local anaesthetic and wait
-use laryngoscope
What signs may indicate the tube is blocked or kinked?
-sp02 very low
-little movement of reservoir bag
-cyanosis
What to do if the tube is blocked or kinked?
-remove and replace with clean tube
What signs may indicate tracheal rupture?
-sub cut emphysema
-reduced breath sounds
What to do if the trachea has ruptured?
-alert vet
-deflate cuff
-move tube past tear
-re inflate
When to extubate dogs?
-when the pharyngeal reflexes have returned
When to extubate cats?
-at ear flick, before vigorous swallowing
When to extubate brachycephalic patients?
-wait until patient coughs/chews
-monitor 02
When to extubate patients with megaoesophagus?
-delayed to prevent regurgitation
