Intubation Flashcards
what equipment do you need for intubation?
ET tubes - min. 3 sizes
laryngoscope
intubeaze
syringe
tie/ WOW bandage
swabs (better hold of the tongue)
stylet and urinary catheter
- for difficult intubations
why do we intubate?
- provide and maintain a patent airway
- prevent inhalation of foreign material (regurg)
- administer O2 and anaesthetic agents
- remove waste anaesthetic gases
- facilitate IPPV
- allow close respiratory monitoring
- administer emergency drugs intratracheally
what size ET tube should you pick?
length:
measure from incisors to scapula
width:
measure using nasal philtrum or according to weight
always have 3 sizes - ideal then one above and below
why is choosing the correct ET tube important?
if too long then will sit at the bifurcation so only supply one lung
- reduced respiratory function during GA
What checks need to be made on an ET tube?
inflate the cuff and leave for 30 mins
- should also be checked every 30mins of anaesthesia
check for damage or contamination if reused
what are the different types of ET tubes?
Red Rubber
PVC
Silicon
What are the features red rubber ET tubes?
Durability - Not long term
Repairable - No
Size - 2-15mm
Autoclavable - yes
Mold to shape - no
Withstand kink - no
Irritant - yes
Expensive - ++
Blockages visible - no
Pre-formed curve - yes
Ease of insertion - easy
Self-sealing balloon - no
Types of cuff - low volume, high pressure
what are the features of PCV ET tubes?
Durability - disposable
Repairable - no
Size - 2-11mm
Autoclavable - no
Mold to shape - yes
Withstand kink - better than rubber
Irritant - no
Expensive - +
Blockages visible - yes
Pre-formed curve - yes
Ease of insertion - easy
Self-sealing balloon - yes
Types of cuff - high volume, low pressure OR low volume, high pressure
what are the features of silicon ET tubes?
Durability - reusable
Repairable - yes
Size - 2-30mm
Autoclavable - yes
Mold to shape - yes
Withstand kink - better than rubber
Irritant - no
Expensive - +++
Blockages visible - yes
Pre-formed curve - no
Ease of insertion - may need stylet
Self-sealing balloon - yes
Types of cuff - low volume, high pressure
step-by-step for intubation
check ET tubes
administer induction agent (IV)
- check jaw one relaxed and no blink
lube tube/spray intubeaze
assistant holds head up and mouth open
pull tongue down and hold with laryngoscope
use laryngoscope to pull back the epiglottis
insert a tube down the trachea
connect to circuit
cuff tube
tie behind canines for stability
leak test
what are the pros and cons of v-gels?
pro
- less risk of tracheal damage
con
- higher risk of displacement
what are the possible reasons for difficult intubation?
species - rabbits and guinea pigs hardest
breed - brachycephalics
facial/neck trauma
pharyngeal swellings
inability to open mouth (eg tetanus)
what can you do if difficulty intubating is caused by poor visualisation?
check to position - head and neck straight?
check if epiglottis is caught on the soft palate
ensure the tongue is fully pulled out
add additional tongue depressor
use suction to remove excess saliva
what can you do if difficulty intubating is because you can advance through the glottis?
use a smaller ETT
use the bevel to aim towards the ventral glottis
use a stylet or urinary catheter through the ETT
what should you do if you can’t intubate and the patient isn’t ventilating?
announce emergency situation
attempt mouth-nose breaths
perform tracheostomy
prepare for CPR
