ETTs and intubation

Question 1

what is the function of an ETT?

Answer 1

secures airway, controls airway, delivers O2 and gas anesthetics

Question 2

what are the different types of ETTs?

Answer 2

oropharyngeal or nasopharyngeal
cuffed or uncuffed

Question 3

murphy eye

Answer 3

safety feature
hole on one side of the end of the tube
makes sure other bronchi that the bevel isn’t in doesn’t get blocked

Question 4

cuff

Answer 4

seals off tube within trachea for safety and patency
aka pilot balloon
properly inflate, may cause tracheal necrosis
+/- anti-over-inflation mechanisms

Question 5

placement of an ETT

Answer 5

tip of nose or incisors to mid-trachea thoracic inlet

Question 6

types of ETTs

Answer 6

silicone rubber, cole style silicone, polyvinyl chloride, red rubber, PVC without cuff

Question 7

ETT cuffs

Answer 7

barrel shaped: high volume, low pressure
oval shaped: low volume, high pressure

Question 8

how to select an ETT

Answer 8

as big as will comfortably fit (grab 1 smaller and 1 bigger just in case)
determine diameter: nasal septum/philtrum and measure against ID
by wt: 25 lb dog ~ #7
palpate trachea and compare to ID of ETT
measure length to both ends: between larynx and thoracic inlet

Question 9

length of ETT problems

Answer 9

too far down can go past tracheal bifurcation (enters 1 main pulmonary bronchi and only inflates 1 side of lungs which causes respiration problems with gas levels)
too far down beyond incisors: creates dead space and causes rebreathing of exhaled gas, can cut ETT if needed to shorten and replace 15mm adaptor

Question 10

how do you put in an ETT?

Answer 10

insert the blade of the laryngoscope under the epiglottis at the base of the tongue and press down firmly to see trachea
hold laryngoscope in non dominant. hand with tongue between 1st and 2nd fingers, keep everything central to avoid distorting trachea

Question 11

where are the arytenoid cartilages located?

Answer 11

on either side of the hole at the back of the throat

Question 12

placement and tie in of ETT

Answer 12

get tongue positioned out of mouth safely
use ETT to push tongue out of the side of the mouth
grab tongue with gauze in your hand
extend tongue between lower canine teeth, not over them so the patient can’t accidentally bite and puncture their tongue
use sterile lubed tube on cuff
place ETT curve down
use stylet and lidocaine for cats
tie in place

Question 13

how should you tie in an ETT?

Answer 13

use roll gauze
tie behind the ears or on the snout (maxilla or mandible right behind canine teeth)

Question 14

what happens if you over inflate the cuff?

Answer 14

it can tear a hole in the trachea

Question 15

ETT placement verification

Answer 15

do after cuff inflation before and after attaching to anesthetic machine
check for steam in the tube or feel for air (can also palpate throat below larynx, auscultate both lungs for air flow, PPV and watch chest while listening for leaks, spontaneous breath moves bag appropriately)

Question 16

laryngoscope

Answer 16

inspect and clean before use
blades remove/attach to handle with some effort
don’t leave on for a long period of time because it gets hot

Question 17

anesthetic masks

Answer 17

cone shaped device used to deliver O2 and anesthetic gas
use for dyspneic patients, induction, or maintenance
otherwise not preferred because it can cause high anesthetic pollution and it doesn’t secure airway)
remove the rubber ring when delivering O2

Question 18

anesthetic chamber

Answer 18

clear plastic rectangular box used to induce anesthesia in feral, fractious, or distressed patients
has 2 ports: fresh gas inlet port, waste gas exit
place patient in the chamber, close, attach circuit and waste hose to chamber, turn on O2 2-3 L/min and iso at 5%, once patient is anesthetized swiftly take box outside for aeration
not preferred because it’s irritating, stressful, and you can’t monitor vitals
gain venous and airway access ASAP after taking patient out
may be used for O2 delivery