ENDOTRACHEAL INTUBATION

Question 1

WHAT IS ENDOTRACHEAL INTUBATION?

Answer 1

 Tubes inserted into the trachea and is used to conduct gases and vapours to and from the lungs
 Endotracheal intubation is the most direct and satisfactory method of securing the airway.
 Tubes can be cuffed and of different sizes

Question 2

DISTINGUISH THE TYPES OF INTUBATION

Answer 2

Types of intubation
* Oral intubation
i. Direct laryngoscopy
ii. Video laryngoscopy
* Nasal intubation
i. Blind nasal intubation
ii. Using laryngoscope and magills forceps
iii. Fibre optic intubation - using fibre optic scope

Question 3

WHAT ARE THE INDICATIONS FOR ENDOTRACHEAL INTUBATION?

Answer 3

a) Main indication for intubation is airway protection/control of airway:
b) Facilitate artificial ventilation
c) Facilitate surgery around face or neck
d) Protect lungs if risk of pulmonary aspiration esp Loss of gag/cough reflex e.g. head injury with GCS <8 (to
prevent massive aspiration).
e) Cardiac arrest
f) Serious Head Injury
g) Inhalational burns
h) Airway obstruction: acute laryngeal edema – e.g. inhalation burn, Ludwig’s angina, epiglottitis
i) Anticipated loss of control of the airway: anticipated laryngeal oedema– e.g. neck trauma, acute stridor etc

Question 4

WHAT ARE THE WILSON RISK FACTORS FOR ENDOTRACHEAL INTUBATION?

Answer 4

Wilson risk factors
Each scores 2 points-Maximum 10 points and a Score >2 predicts
75% of difficult intubations (high false positive!)
 Obesity ……2.
 Restricted head and neck movements ……2
 Restricted mandibular movement ……2
 Receding mandible ……2 Total 10
 Prominent front teeth ……2

Question 5

OUTLINE THE PROCESS FOR A DIRECT LARYNGOSCOPY ENDOTRACHEAL INTUBATION

Answer 5

Endotracheal intubation- Direct larnygoscopy
 Assemble all needed equipment, while patient is being ventilated
 Choose appropriate ET tube size
 Check balloon with 10cc of air
 Place stylet, stopping approximately ½ inch short of the
end of the tube (optional)
 Assemble laryngoscope and check it’s light
 Connect and check suctioning device
 Put the patient in “sniffing” position (neck flexed forward, head extended back, and back of head should be
level with or above the shoulders). Premedication (atropine/sedatives)
 If cervical spine injury is suspected, have an assistant hold the patient’s head in a neutral position.
 Pre-oxygenate the patient with 100% oxygen- to replaces the nitrogen
volume of the lungs (69% of FRC) with oxygen via tight-fitting mask for
5 minutes →up to 10 min of O2 reserve following apnea
 Open the mouth with right hand (Scissor technique)
 Insert laryngoscope to right of the midline. Move to midline, pushing the
tongue to the left. Careful with insertion not to hit teeth
 Advance laryngoscope further into oropharynx with applied traction 450
.
Lift straight up on the blade to expose posterior pharynx.
 Identify the epiglottis; tip of curved (Macintosh) blade should sit in
valeculla (in front of the epiglottis), straight blade should slip over the epiglottis. Once epiglottis visualized, push laryngoscope into vallecula and apply traction at 450
angle to
“push” epiglottis up and out of the way. Sellick’s manourve may help to visualize the cord
 With further, gentle traction, identify trachea and arytenoid cartilages and vocal cords
 Insert ET tube along the blade, into the trachea and advance the tube 1-1.5
inches beyond the cords and inflate the cuff. Insert ETT above and between
arytenoids and through vocal cords. Try to visualize the ETT passing
between the vocal cords
 Ventilate and watch for chest rise and fall.
 Listen for breath sounds, over stomach, four lung fields and axillae. (If
breath sounds are diminished or absent on left side, indicating a right main
stem intubation, slightly pull tube back and reassess breath sounds).
 Note number on the side of ET tube at the central incisor and secure tube.
 Reassess breath sounds, now and any time the patient is moved.

Question 6

WHAT ARE THE EARLY COMPLICATIONS OF ENDOTRACHEAL INTUBATION?

Answer 6

Early
(i) Accidental esophageal intubation loss of airway control
(ii) Accidental intubation of main bronchus or RT
(iii) Trauma to larynx, tracheal or teeth
(iv) Aspiration of vomitus during intubation
(v) Laryngo- tracheal perforation bleeding

Question 7

WHAT ARE THE LATE COMPLICATIONS OF ENDOTRACHEAL INTUBATION?

Answer 7

Late
(i) Disconnection or blockage of tube
(ii) Infection vocal cord granulomas
(iii) Delayed tracheal stenosis due to prolonged intubation