Artificial Airways Orotracheal Intubation

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Artificial Airways - Orotracheal Intubation

• RET 2275L
• Respiratory Therapy Theory Lab 2
• Module 1.1

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Orotracheal Intubation

• Safely performed by
• Physicians
• Respiratory Therapists
• Nurses
• Paramedics

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Orotracheal Intubation

• Step 1 Assemble and Check Equipment
• Suction Equipment
• Suction regulator, canister, tubing, catheters,
  Yankauer (tonsil tip)
• Manual resuscitator bag and mask
• O2 flowmeter and tubing
• Laryngoscope with assorted blades
• Endotracheal tubes
• Inflate cuff and check for leaks

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Orotracheal Intubation

• Step 1 Assemble and Check Equipment
• Stylet
• Magil forceps (nasal intubation)
• Tongue depressor
• Tape
• Syringe
• Lubricating jelly
• Local anesthetic (spray)

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Orotracheal Intubation

• Step 1 Assemble and Check Equipment
• Towels (for positioning)
• Stethoscope
• CDC barrier precaution
• Gloves, gowns, masks, eyewear

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Orotracheal Intubation

• Step 2 Position the Patient
• Must align the mouth, pharynx and larynx
• Place one or more rolled towels under the
  patients head

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Orotracheal Intubation

• Step 3 Preoxygenate the Patient
• Provides a reserve of oxygen during intubation
  attempts
• Intubation attempts should not last greater than
  30 seconds
• If attempt fails, ventilate and oxygenate for 3-5
  minutes before reattempting to intubate

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Orotracheal Intubation

• Step 4 Insert the Laryngoscope
• Laryngoscope in left hand while right hand opens
  the mouth
• Insert the laryngoscope into the right side of
  the mouth and move it toward the center,
  displacing the tongue to the left
• Advance the tip of the blade along the curve of
  the tongue until you visualize the epiglottis

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Orotracheal Intubation

• Step 5 Visualize the Glottis

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Orotracheal Intubation

• Step 6 Displace the Epiglottis
• MacIntosh Blade displaces the epiglottis
  indirectly by advancing the tip of the blade into
  the vallecula
• Miller Blade displaces the epiglottis directly
  by advancing the tip of the blade over the its
  posterior surface and lifting the laryngoscope up
  and forward

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Orotracheal Intubation

• Step 7 Insert the Tube
• Insert the tube from the right side of the mouth
• Advance tube through the glottis until the cuff
  passes the vocal cords
• Inflate the cuff to seal the airway
• Ventilate and oxygenate

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Orotracheal Intubation

• Step 8 Assess Tube Position (5 cm above carina)
• Auscultation
• Observation of chest movement
• Tube length (cm to teeth)
• Colorimetry
• Capnometry
• Light wand
• Fiberoptic laryngoscope
• Esophogeal detection device
• Chest x-ray

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Orotracheal Intubation

• Step 9 Secure the Endotracheal Tube