Nasal Endotracheal (Ett) Intubation

Front 1

What is the first thing required in Nasal Endotracheal (ETT) Intubation?

Back 1

Recognize the need for ventilatory assistance or airway control.

Front 2

You recognize the need for ventilatory assistance or airway control, what do you want to start initially?

Back 2

Initiate basic airway management - modified jaw thrust & nasal airway.

Front 3

You have initiated basic airway management skills but they are not effective, what now?

Back 3

You realize basic airway management is inadequate or ineffective - but the pt. is breathing.

Front 4

You now realize that basic airway management is inadequate or ineffective, but the pt. is breathing. what now.

Back 4

Do not rush to ETT if pt.

• is <50 yrs of age, and currently experiencing episodes of asthma exacerbation (unless the pt. is in or near cardiac arrest)
• Has no basal skull or mid face fractures
• has no uncontrolled epistaxis
• is not receiving anticoagulant therapy (no bleeding disorders)

Front 5

What will you want to do after the exclusion criteria have been ruled out?

Back 5

Display use of universal precautions - (gloves / goggles)

Front 6

You also want to affirm one thing:

Back 6

That the pt.'s age is >= 8 years of age

Front 7

What will you want to do next?

Back 7

Prepare the nostrils

Front 8

How will you begin to prepare the nostrils?

Back 8

Administer Xylomethazoline 0.1% spray, 2 sprays per nare once (ensure no allergy / sensitivity)

Front 9

After Xylomethazoline 0.1% spray, what will you want to use?

Back 9

Lidocaine spray to nares: 10mg/spray - max. dose 5mg/kg - max. 20 sprays

Front 10

After Lidocaine spray to the nares, what will you want to do?

Back 10

Pre-oxygenate the patient 30-60 seconds, put the pt. to semi to full sitting position.

Front 11

After pre-oxygenating and setting the patient to mid/full fowlers, what will you want to do?

Back 11

Assemble the equipment using the SLOPES mnemonic

Front 12

What does the S stand for in the SLOPES mnemonic?

Back 12

Suction Ready

Front 13

What does the L stand for in the SLOPES mnemonic?

Back 13

Lidocaine ready

Front 14

What does the O stand for in the SLOPES mnemonic?

Back 14

Oxygenate pt. (have BVM ready to go)

Front 15

What does the P stand for in the SLOPES mnemonic?

Back 15

Proper positioning (pt. sitting upright in mid or full fowlers)

Front 16

What does the E stand for in the SLOPES mnemonic?

Back 16

Selects proper ETT tube

• #6 - small adult
• #7 - female adult
• #8 - male adult

Front 17

What does the S stand for in the SLOPES mnemonic?

Back 17

Stylet ready (does not insert past the islet - 1.0-1.5cm prior to the tip of the tube)

Front 18

After completing your SLOPES mnemonic what will you want to do?

Back 18

Select the most appropriate nare / largest, often the right. Ensure no deviation, remove the NPA if applicable.

Front 19

After selecting the right nare and removing the NP airway, what will you do?

Back 19

Lubricate the tube and insert the ET tube directly backwards into the nare (key points - do not force the tube against any obstructions / lifting the nose slightly may assist with initial insertion)

Front 20

After lubricating and beginning to insert the ET tube directly backwards into the nare, what will you do next?

Back 20

Stop when entering the hypopharynx

Front 21

You have stopped at the hypopharynx, what now?

Back 21

Listen to the end of the ET tube for sounds of breathing.

Front 22

You begin to hear breath sounds out of the end of the ET tube, what will you do next?

Back 22

Encourage the pt. to take a deep breath if able to.

Front 23

The patient has taken a deep breath, what do you do?

Back 23

Smoothly advance the tube through the glottis opening during inhalation. At this point you are pulling gently on the trigger as you advance.

Front 24

You have advanced the tube through the glottis opening during inhalation, what should you notice now?

Back 24

You should hear air leaving the end of the tube (misting)

Front 25

Once you hear air leaving the end of the tube (misting) what will you do next?

Back 25

Inflate the cuff with 5-10cc of air and listen for leakage from the pt.s mouth.

Front 26

You do not hear any air or notice leakage from the pt's mouth, what do you do now?

Back 26

Attach the superset / filter device (proper assembly required) with BVM & Oxygen

Front 27

You have attached the superset / filter device with BVM and oxygen, what do you want to do now?

Back 27

Attach ETCo2 to the monitor, confirm proper waveform with the monitor (35-45 good waveform)

Front 28

After you have attached ETCo2 to the monitor, what do you want to do now?

Back 28

Confirm tube placement with:

• Auscultation (5 point auscultation)
• Visualize good chest rise and fall

Front 29

What is your final step of the nasal ETT intubation?

Back 29

Secure the tube with a tie (try going through the ring to secure the tube)