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Title:

Orotracheal Intubation

Description:

... and auscultate Confirm placement with an ETCO2 detector Secure tube Reconfirm tube placement Field Extubation Prepare intubation equipment and suction ... – PowerPoint PPT presentation

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Title: Orotracheal Intubation


1
Orotracheal Intubation
  • Optional, AEMT

2
Course Objectives
  • Describe Sellicks maneuver and the use of
    cricoid pressure during intubation.
  • Describe the necessary equipment needed to
    perform orotracheal intubation.
  • Describe the indications, advantages,
    disadvantages, and complications of orotracheal
    intubation.
  • Describe the visual landmarks for direct
    laryngoscopy.

3
Course Objectives
  • Describe steps to perform orotracheal intubation.
  • Describe the methods of assessing, confirming,
    and securing correct placement of an orotracheal
    tube.
  • Describe the technique for extubation.

4
Sellicks Maneuver
  • Helps prevent regurgitation and reduces gastric
    distention.
  • Locate the cricoid cartilage by palpating the
    thyroid cartilage and the feel the depression
    just below it (cricothyroid membrane).
  • Using your thumb and index finger of one hand,
    apply pressure to the anterior and lateral
    aspects of the cricoid cartilage just next to the
    midline.
  • See picture on next slide.

5
Sellicks Maneuver
6
Airway Before Applying Sellicks
7
Airway with Sellicks Applied (Note compression
on the esophagus.)
8
Oraltracheal Intubation Equipment
  • Laryngoscope handle and blade
  • Endotracheal tube
  • 10 ml syringe
  • Stylet
  • BVM
  • Suction device
  • Bite block
  • Magill forceps
  • Tape or tube-holding device

9
Laryngoscope Blades
10
Engaging Laryngoscope Blade and Handle
11
Activating Laryngoscope Light Source
12
Placement of Macintosh Blade into Vallecula
13
Placement of Miller Blade under Epiglottis
14
Endotracheal Tube
  • 5.0 mm-9.0 mm (cuffed)
  • Distal end has a beveled tip for smooth movement
    through airway passages.
  • Length ranges from 12cm-32cm.
  • Typical size for an average adult male is 7.5-8.5
    mm
  • Typical size for an average adult female is
    7.0-8.0 mm

15
Tube and Syringe
16
Tube, Stylet, and Syringe, Unassembled
17
Tube, Stylet, and Syringe, Assembled for
Intubation
18
Magill Foreceps
19
Tube-Holding Device
20
Oraltracheal Intubation Indicators
  • Respiratory or cardiac arrest
  • Unconsciousness
  • Risk of aspiration
  • Obstruction due to foreign bodies, trauma,
    burns, or anaphylaxis
  • Respiratory extremis due to disease
  • Pneumothorax, hemothorax, hemopneumothorax with
    respiratory difficulty

21
Advantages of Oraltracheal Intubation
  • Isolates trachea and permitscomplete control of
    airway
  • Impedes gastric distention
  • Eliminates need to maintain a mask seal
  • Offers direct route for suctioning
  • Permits administration of some medications

22
Disadvantages of Endotracheal Intubation
  • Requires considerable training and experience
  • Requires specialized equipment
  • Requires direct visualization of vocal cords
  • Bypasses upper airways functionsof warming,
    filtering, and humidifying the inhaled air

23
Complications of Oraltracheal Intubation
  • Equipment malfunction
  • Teeth breakage and soft tissue lacerations
  • Hypoxia
  • Esophageal intubation
  • Endobronchial intubation
  • Tension pneumothorax

24
Visual Landmarks
25
Hyperventilate the patient
26
Prepare and Test Equipment
27
Apply Sellicks maneuver and insert laryngoscope
28
Visualize glottis through laryngoscopy
29
Inflate cuff, ventilate, and auscultate
30
Confirm placement with an ETCO2 detector
31
Secure tube
32
Reconfirm tube placement
33
Field Extubation
  • Prepare intubation equipment and suction
  • Confirm patient responsiveness
  • Suction the patients oropharynx
  • Deflate the cuff
  • Remove the tube upon cough or expiration
  • Provide supplemental oxygen as needed
  • Reassess the adequacy of the patients
    ventilation and oxygenation

34
Summary
  • Sellicks manuever
  • Necessary equipment to perform orotracheal
    intubation
  • Indications, advantages, disadvantages, and
    complications of orotracheal intubation
  • Visual landmarks
  • Steps to perform orotracheal intubation
  • Methods of assessing, confirming, and securing
    correct placement of an orotracheal tube
  • Technique for extubation
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