Intubation.txt

• Partial
• Complete

• 1. Airway Compromise
• 2. Respiratory failure (and to facilitate ventilation)
• 3. Need to protect the airway

• 1. Persistent apnea
• 2. Cardiopulomnary arrest
• 3. Accidental extubation of mechanically ventilated patient
• 4. Upper airway or laryngeal edema
• 5. Loss of protective reflexes
• 6. Coma with increased ICP
• 7. Massive upper airway bleeding

• 1. Inability to protect airway
• 2. Apnea
• 3. Hypoxemia
• 4. Respiratory distress
• 5. Partially obstructed airway
• 6. Complete airway obstruction

• - Failure to establish a patent airway, to intubate the trachea, or revognize esophageal intubation
• - Trauma to nose, mouth, tongue, pharynx, larynx, vocal cords, trachea, esophagus, spine, eyes, and most common are the TEETH!
• - Aspiration and/or infection (pneumonia, sinusitis, otitis media)
• - ET tube problems (cuff, pilot balloons, kinking, occlusion, extubation)
• - Autonomic or protective neural responses (hypo/hypertension, brady/tachcardia, dysrhythmias, laryngospasm, bronchospasm)
• - Bleeding

• ET tube position:
• - Regardless of the method of ventilation used, the most important consideration is detection of esophageal intubation
• - Tracheal intubation is suggested but may not be confirmed by:
• --bilateral breath sounds over the chest,
• --symmetrical chest movement, and absence of ventilation sounds over the epigastrium,
• --presence of condensate inside the tube corresponding with exhalation,
• --visualization of the tip of the tube passing through the vocal cords not esopageal

• Tracheal intubation is confirmed by detection of CO2 in the exhaled gas, although cases of transient CO2 excreation from the stomach have been reported
• Tracheal intubation is confirmed by endoscopic visualization of the carina or tracheal rings through the tube
• Chest Xray!

• The ASA task force described the difficult airway as:
• one that a "conventionally trained" anesthesiologoist cannot managed without systemic desaturation despite increased FiO2, and asymptomatic

It is an airway that is hard to manage due to anatomy or medical conditions that make ventilation or intubation more difficult than normal.

• Divided into Class I, II, III, IV
• I easiest (soft palate, uvula, fauces and pillars visible), IV hardest (only hard palate visible)
• A validated index of direct laryngocopy (DL) difficulty by visual inspection and grading of tongue and pharyngeal proportions with maximal mouth opening

Rapid Sequence Intubation: Administration of a sedative and a paralytic to facilitate

• Can help diminish risk of aspiration
• Patients with head injuries and respiratory exhaustion
• Patients with burns
• Patients with certain overdoses
• Patients with facial injuries
• Patients with cerebrovascular accidents (CVAs).
• On certain patients with Congestive Heart Failure (CHF)
• Very careful attention should be paid to the patient in
• CHF
• - Performing RSI on these patients should be performed only after medications have failed

• 1. Suction equipment
• 2. Oxygen
• 3. BVM
• 4. Working laryngoscope
• 5. ET tubes and stylets
• 6. Gum Elastic Bougie
• 7. Bite blocks
• 8. Tape
• 9. ETCO2 detector
• 10. Syringe
• 11. Lubricant

• Etomidate .5 mg/kg IVP (typical dose is 20-40mg IVP)
• Succinylcholine (anectine) 200 mg IVP (1.5 mg/kg)
• Too little used, may make intubation difficult
• Lidocaine
• Atropine (especially in the case of Bradycardia)
• Midazolam (Versed)
• .2 mg/kg IVP for induction
• .1 mg/kg IVP for maintenance
• Fentanyl, Dilaudid, or Demerol may also be used in conjunction at times. However, excessive amounts may preclude patient�s breathing

• ventilate and retry
• Gum Elastic Bougie
• LMA
• Glidescope