Oral Endotracheal (Ett) Intubation

Front 1

What is your first step in Oral Endotracheal (ETT) Intubation

Back 1

to recognize the need for ventilator assistance or airway control.

Front 2

After you have recognized the need for ventilator assistance or airway control, what will be your next step?

Back 2

To initiate basic airway management skills:

1) OP / NP Airway

2) King LT

Front 3

After you have initiated your basic airway management skills what will be your next step?

Back 3

You now realize your basic airway management skills are inadequate or ineffective.

Front 4

Your basic airway management skills are inadequate or ineffective, what is your next step?

Back 4

Consider the following questions:

1) Is the patient <50 yrs old and currently experiencing an Asthma Exacerbation Episode?

AND

2) Is the pt near cardiac arrest?

Front 5

Considering the following questions:

1) Is the patient <50 yrs old and currently experiencing an Asthma Exacerbation Episode?

AND

2) Is the pt near cardiac arrest?

What will you do if the answer is yes to any of these questions?

Back 5

Do not rush to ETT, consider other basic airway maneuvers.

Front 6

Next how are you going to begin to prepare for Oral Endotracheal (ETT) Intubation?

Back 6

Consider universal precautions

1) Gloves

2) Goggles

3) Gown if necessary

Front 7

What are you going to do next after donning your personal protective equipment?

Back 7

Pre oxygenate the patient for 30 - 60 seconds.

Front 8

After you have pre oxygenated the patient for 30 - 60 seconds, what will you want to do next?

Back 8

Consider the SLOPES mnemonic to prepare your equipment.

Front 9

Name the S in the SLOPES mnemonic

Back 9

Suction Ready

Front 10

Name the L in the SLOPES mnemonic

Back 10

Laryngoscope, Lidocaine spray, Light (Bright White & Tight)

Front 11

Name the O in the SLOPES mnemonic

Back 11

Oxygen (oxygenate the patient, BVM ready), OP airway

Front 12

Name the P in the SLOPES mnemonic

Back 12

Proper Positioning

• Ensure you are properly positioned
• Ensure your patient is properly positioned in the sniffing position (pillow, phone book or blanket works well)

Front 13

Name the E in the SLOPES mnemonic

Back 13

Select the proper ET tube

• Male 7-8 mm
• Female 6-7 mm

Front 14

Name the final S in the SLOPES mnemonic

Back 14

Stylette

• inserted into the tube until the

Syringe

• 10cc syringe ready to inflate cuff.

Front 15

After you have gone through the SLOPES mnemonic, which next mnemonic will you want to consider?

Back 15

the LEMON mnemonic for difficult airway assessment.

Front 16

Name the L in the LEMON mnemonic

Back 16

L = Look externally, e.g. short neck, large tongue, large teeth, etc

Front 17

Name the E in the LEMON mnemnonic

Back 17

E = Evaluate 3-3-2

- 3 = adequacy of oral access

- 3 = to assess capacity of mandibular space to accommodate tongue

- 2 = distance of larynx to level of base of tongue

Front 18

Name the M in the LEMON mnemnonic

Back 18

M = Mallampati scoring

- Difficulty to sit up; use tongue depressor, etc

- difficult to do proper, complete Mallampati

Front 19

Name the O in the LEMON mnemonic

Back 19

O = Obstruction

Any signs of upper airway obstruction?

three cardinal signs of upper airway obstruciton:

- muffled voice (hot potato voice),

- difficult swallowing secretions,

- stridor; when stridor happens, consider that circumference of airway reduced to roughly 10% of normal caliber!!!!

Front 20

Name the N in the LEMON mnemonic

Back 20

N = Neck mobility

Front 21

After you have gone through your LEMON mnemonic, what will you want to do next?

Back 21

Open the mouth, inspect and remove any loose dentures and / or debris

Front 22

After you have opened the mouth and cleared any debris, what will you want to do next?

Back 22

Grasp the Laryngoscope.

Front 23

Which hand will you want to grasp the Laryngoscope in?

Back 23

The Left hand

Front 24

What will you want to do next?

Back 24

Insert the laryngoscope and move the tongue to the left.

Front 25

After you have inserted the laryngoscope and moved the tongue to the left, what will you want do do next?

Back 25

Advance the blade into the proper position in the vallecula and lift the epiglottis, visualizing the glottic opening and surrounding structures.

Front 26

After you have visualized the chords, what will you do next?

Back 26

Insert the tube (using the right hand) in the right corner of the mouth (stay off teeth with blade)

Front 27

After you have inserted the tube in the corner of the mouth what will you want to do?

Back 27

Observe the tube pass through the cords (1 - 2.5cm past cords and notice placement at the teeth)

Front 28

After your tube is placed, and the height of the tube is observed at the teeth, what will you want to do?

Back 28

Inflate the cuff with 5-10 cc of air.

Front 29

After you have inflated with 5-10 cc of air, what will you do next?

Back 29

Attach the superset / filter device (proper assembly required) with the BVM and oxygen.

Front 30

Your superset, filter device BVM and oxygen are attached. What will you do next?

Back 30

Attach the ETCo2 to the monitor, confirm placement with proper waveform.

Front 31

After your ETCo2 is attached and proper waveform is confirmed, what other confirmation methods do you want to use?

Back 31

Auscultation of 5 points:

• epigastrium
• 4 lung fields
• trachea

Visualize for chest rise

Front 32

After you tube has been confirmed in place, what to you want to do as a last step?

Back 32

Secure the tube with a Thomas tube tie.