Endotracheal Intubation Flashcards
Why do we intubate? (Name 3 reasons)
- Maintain airway (anaesthesia removes voluntary control of the airway )
- Anaesthesia abolishes protective airway reflexes e.g. coughing
- Prevent aspiration pneumonia
- Prevent laryngospasm
- Reduce environment pollution
- Allow IPPV
Why is mask airway not as good as ET? Name 3 reasons
- Mask increases pollution
- Never direct regardless of how hard you try
- Not particularly efficient
- Doesn’t secure an airway
- may find sizes difficult?
What kind of animals is mask airway most commonly used on?
exotics, birds, small furries
Explain 2 ways to get the correct ET tube?
- Tip of incisor to spine of scapula compare to palpable width of trachea
- Palpate trachea to feel how wide it is
- Look at space between the nostrils
What equipment is required?(7 things)
- Suitable sized ET tube
- Tube tie
- Mouth gag
- Syringe to inflate cuff
- Lubricant
- Laryngoscope
- Local anaesthetic spray
Name the 4 kinds of ET tubes
- Red rubber
- PVC
- Silicone
- Murphy eye tubes
Name 3 benefits of using a PVC over a red rubber ET tube?
- Red rubber is not see through (PVC is transparent so can see for any obstructions)
- Red rubber has a low volume high pressure cuff which is more likely to cause damage to the trachea (PVC is high volume low pressure cuff)
- Even if you over inflate the cuff the PVC is less likely to cause tracheal damage than Red Rubber
- PVC lasts longer
What kind of ET tube is recommended in cats?
Uncuffed
Why must you be careful when inflating an ET tube cuff?
- tracheal damage
- high mortality incidence with ET intubation
What checks should you do prior to use of an ET tube?
- ensure it is the correct size
- Make sure it is clean
- Make sure the cuff is operational
- Make sure it is not damaged / perished / is in date
For ‘Gold standard’ how long should you leave the cuff inflated for prior to use?
30 minutes then deflate
Generally what tube size is used for the following: Cat Dogs 10kg Dogs 20kg Dogs 30kg
cat - 4.5-5
Dog 10kg - 8
Dog 20 kg - 10
Dog 30 kg - 12
Name the two types of laryngoscope:
Miller (straight)
Macintosh (curved)
Name 2 reasons why it is dangerous if the patinet is not adequately anaethetised prior to intubation?
- Could be bitten
- Could bite ET tube and section lodged in trachea
Explain the steps of intubating a patient
- Assistant holds animals head / restrains
- Ensure the anaesthetic depth is adequate
- Visualise glottis (with or without a laryngoscope)
- Insert tip of bevel then rotate to follow curve of trachea
- Use topical anaesthetic if required ( spray)
- Check placement and secure
- Inflate cuff if apt
How do you know if the patient is intubated correctly?
- Palpate within the trachea
- Ausculate both lung fields
- Observe movement in reservoir bag
- check for air movement
Name 4 disadvantages of intubation/
- Increased airway resistance if tube too narrow
- Kinking or occlusion of tube
- Iatrogenic trauma to larynx
- Irritation to mucosa if tube not rinsed
- Over inflation of cuff causing tracheal damage
- Endo-bronchial intubation
- Misplacement
Give 2 reasons why a patient may be difficult to intubate:
- patient too light
- Anatomical problems e.g. brachycephalics
- Trauma
What should you do prior to intubating if you think a patient may be difficult to intubate?
Pre-oxygenate for at least 5 minutes
Name 3 potential ET tube problems?
- Tube in oesophagus
- Tube lodged in bronchus
- Laryngospasm in cats
- Tube blocked or kinked
- Tracheal rupture
What could a tube in the oesophagus cause?
- Patient doesn’t stay asleep
What would tube lodged in bronchus cause?
- Patient wakes up
How do you tell if tube is lodged in oesophagus?
- patient wakes up
- Low spO2 on pulse oximeter
- Low/little movement of reservoir bag
How do you tell if tube is lodged in bronchus?
- spO2 is greatly reduced
- Unilateral breath sounds
- patient wakes up
How do you prevent laryngospasm in cats?
- Use 1 spray of local anaesthetic and wait
- Use laryngoscope
- If problems oxygenate and wait
How do you tell if there is a blocked or kinked ET tube?
- spO2 very low
- Little movement of reservoir bag
- Cyanosis
How do you tell if there is a tracheal rupture?
- Sub-cut emphysema
- Reduced breath sounds
How do you extubate your patient?
- Wait until pharyngeal reflexes have returned
- Make sure the oropharyngeal area is free of debris/blood
- Wait until patient coughs/chews if brachycephalic and monitor oxygen
What may the patient suffer from if reflexes are delayed?
Megaoesophagus
