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orotracheal intubation

Stabilize tube/confirm placement


:listen for equal and bilateral breath sounds as patient is being ventilated


:observe chest wall for adequate and equal chest expansion


:if ETT tube is in airway, chest CO2 levels begin to rise, seen on capnogram



During orotracheal intubation, make sure to visualize Tongue, vallecula, epiglottis, vocal cords, glottis, and arytenoid carlage

Visualizing intubation

Conventional battery operated laryngoscope


:macintosh


:Miller


Fiberoptic bronchoscope


:also may be used for difficult intubations


Videoscope, fiberoptic laryngoscope

Optical camera attached to the end of the laryngoscope


:allows for video of the airway to be shown on a screen


:"glidescope" make intubations easy and safe


:very expensive

Capnometry: CO2 monitoring (brand name easy cap i and easy cap ii

Colormetric capnometry (used if intubating in the field by EMTs)


:For ETT tube placement


:CPR, to detect CO2 which shows if circulation is happening.


5% is normal exhaled CO2, which is desired so if your not totally yellow on colorimeter, not getting sufficient compressions.



End tital CO2 or PetCO2 is the most accurate for CO2 measurement because its the most enriched at the end of your breath



760-47= 713x .05 = 35torr which is the torr of CO2 at sea level expired at 5% CO2 so remember 35 torr is the pressure of CO2 exhaled at sea level 5%


If they exhale at 3.8% what torr would that be 27.094 torr

Endotracheal intubation Potential complications

Early


:esophageal intubation


:Mouth, teeth, nose trauma


:R mainstem bronchus intubation


:Kinded ETT


:vomiting/aspiration


Late


:Vocal cord damage


:Tracheal stenosis


:Infection

Endotracheal intubation indications

Maintain patent airway


Support mechanical ventilation


Need airway access

Orotracheal intubation to assess endotracheal tube position

Ausculation of chest and abdomen


Observation of chest movement


Tube length (cm to teech)


esophageal detection device


Light wand


Capnometry


Colorimetry


Fiberoptic laryngoscopy or bronchoscopy


Videolaryngoscopy

Extubation procedure

Assemble equipment


Towel, scissors, gloves, suction, O2 device, syringe


Explain procedure to patient


Preoxygenate patient, remove ETT tape


Suction oropharynx


Suction ETT


Extubation procedure

Insert catheter


:instruct patient to take a deep breath when instructed to


Deflate cuff and remove the tube swiftly


:Applying suction throughout withdrawl


Apply O2 auscultate lungs and neck for stridor


Check Spo2 instruct patient to DB and C (deep breath and cough)

Assignment

Chapter 20 page 423 to 440