Endotracheal Intubation Overview

A flexible plastic tube inserted through the mouth or nose into the trachea, used to maintain an open airway and ensure proper breathing.

Endotracheal tubes (ETTs) can be used multiple times.

An ETT with two channels, allowing independent ventilation of each lung. One channel goes to the main bronchus, the other stays in the trachea.

Cuffed ETTs are designed for adults and older children, while uncuffed ETTs are used for newborns.

The hook helps secure the ETT in a specific position within the trachea.

Inserting a tube through the mouth or nose into the windpipe (trachea) to maintain an open airway and ensure proper breathing.

The standard method of intubation where the tube is inserted through the mouth.

Intubation performed through the nose, used in specific situations like oral surgery or when oral intubation is difficult.

A nasal skull fracture or an obstruction in the mouth are reasons why nasal intubation is not suitable.

Main purposes of intubation: providing a safe and open airway, controlling breathing, preventing aspiration, and allowing medication administration.

A medical emergency causing cessation of breathing. Requires immediate intervention.

Inability to protect the airway while unconscious. Occurs due to factors like drug overdose or coma.

Checking for a neck injury, large thyroid gland, recent meal intake, alertness and vein access before intubation.

Washing hands and wearing gloves and PPE to prevent the spread of infection during intubation.

Used to isolate one lung from the other to prevent infection or hemorrhage, control ventilation distribution for conditions like bronchopleural fistula, or provide independent lung ventilation during procedures like pneumonectomy or upper lobe resection.

A tube inserted into the trachea to maintain an open airway and allow for controlled breathing. It is typically made of flexible plastic and has an inflated cuff to seal the airway.

Size of ETT is important for proper fit and function. Generally, adult females use 7.5-8mm tubes, adult males 8-9.5mm, while pediatric and neonatal sizes are estimated using a formula based on age.

Components of ETT include Murphy's eye for backup airway, one-way valve to ensure air flow, inflated cuff to seal airway, pilot balloon to inflate cuff, cap for the valve, inflating tube, 15mm adapter for connection, depth markings for placement, and radiopaque line for visibility on x-ray.

Elevating the head 10cm with pads under the occiput and extending the head into a 'sniffing' position aligns the oral, pharyngeal, and laryngeal axis. This creates a nearly straight passage from the lips to the glottis, making intubation easier.

Removing the head board from the bed during intubation provides better access and facilitates a clear view of the airway.

Pre-intubation medications like hypnotics, analgesics, and short-acting muscle relaxants are given to a patient to reduce anxiety, improve cooperation, and facilitate intubation.

Intravenous access is essential before intubation. This is crucial for administering medications, fluids, and monitoring patient's condition during the procedure.

Removing dentures before intubation allows for a clear view of the oral cavity and prevents accidental obstruction of the airway during tube insertion.

Maintaining the head in a neutral position with cervical spine immobilization during intubation ensures the airway remains open and prevents further damage to the spinal cord in patients with potential cervical injuries.

Pre-medicating the trauma patient with sedation helps promote relaxation and reduce discomfort during the intubation procedure.

Applying cricoid pressure during intubation helps to seal the esophagus and prevent stomach contents from entering the airway, ensuring a safe and clear passage for the endotracheal tube.

Hyperoxygenating the patient with 100% oxygen for two minutes before intubation helps ensure adequate oxygen levels in the blood, minimizing the risk of hypoxia during the procedure.

Visualizing the endotracheal tube passing through the vocal cords, observing misting with respirations, and checking breath sounds in both lungs confirm the tube's proper placement in the trachea.

Securing the endotracheal tube (ETT) in place with adhesive tape involves wrapping it around the patient's head and the tube for stability.

Using twill tape, you double it, create a loop, pull the ends around the neck, and tie securely at the side.

After intubation, reposition the patient comfortably, re-confirm correct ETT placement, note the depth, hyper-oxygenate, suction, and take a chest X-ray to verify.

Verify ETT depth at the teeth, using 21cm for women and 23cm for men as a general guide.

Preventing the patient from pulling out the endotracheal tube (ETT) is the main reason for securing it properly.

A straight blade used for intubation, particularly in patients with a short neck, obese patients, and children.

A curved blade often used for intubation due to its ideal angle for visualizing the vocal cords.

A common complication of intubation where the tube accidentally enters the esophagus instead of the trachea.

A potential complication of intubation where damage to the mouth and pharynx can occur, resulting in pain and bleeding.

A rare complication where the ET tube accidentally enters a bronchus instead of the trachea, leading to one-sided ventilation.