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Orotracheal Intubation

Orotracheal Intubation. Optional, AEMT. Course Objectives. Describe Sellick’s maneuver and the use of cricoid pressure during intubation. Describe the necessary equipment needed to perform orotracheal intubation.

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Orotracheal Intubation

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  1. Orotracheal Intubation Optional, AEMT

  2. Course Objectives • Describe Sellick’s maneuver and the use of cricoid pressure during intubation. • Describe the necessary equipment needed to perform orotracheal intubation. • Describe the indications, advantages, disadvantages, and complications of orotracheal intubation. • Describe the visual landmarks for direct laryngoscopy.

  3. Course Objectives • Describe steps to perform orotracheal intubation. • Describe the methods of assessing, confirming, and securing correct placement of an orotracheal tube. • Describe the technique for extubation.

  4. Sellick’s Maneuver • Helps prevent regurgitation and reduces gastric distention. • Locate the cricoid cartilage by palpating the thyroid cartilage and the feel the depression just below it (cricothyroid membrane). • Using your thumb and index finger of one hand, apply pressure to the anterior and lateral aspects of the cricoid cartilage just next to the midline. • See picture on next slide.

  5. Sellick’s Maneuver

  6. Airway Before Applying Sellick’s

  7. Airway with Sellick’s Applied (Note compression on the esophagus.)

  8. Oraltracheal Intubation Equipment • Laryngoscope handle and blade • Endotracheal tube • 10 ml syringe • Stylet • BVM • Suction device • Bite block • Magill forceps • Tape or tube-holding device

  9. Laryngoscope Blades

  10. Engaging Laryngoscope Blade and Handle

  11. Activating Laryngoscope Light Source

  12. Placement of Macintosh Blade into Vallecula

  13. Placement of Miller Blade under Epiglottis

  14. Endotracheal Tube • 5.0 mm-9.0 mm (cuffed) • Distal end has a beveled tip for smooth movement through airway passages. • Length ranges from 12cm-32cm. • Typical size for an average adult male is 7.5-8.5 mm • Typical size for an average adult female is 7.0-8.0 mm

  15. Tube and Syringe

  16. Tube, Stylet, and Syringe, Unassembled

  17. Tube, Stylet, and Syringe, Assembled for Intubation

  18. Magill Foreceps

  19. Tube-Holding Device

  20. Oraltracheal Intubation Indicators • Respiratory or cardiac arrest • Unconsciousness • Risk of aspiration • Obstruction due to foreign bodies, trauma, burns, or anaphylaxis • Respiratory extremis due to disease • Pneumothorax, hemothorax, hemopneumothorax with respiratory difficulty

  21. Advantages of Oraltracheal Intubation • Isolates trachea and permitscomplete control of airway • Impedes gastric distention • Eliminates need to maintain a mask seal • Offers direct route for suctioning • Permits administration of some medications

  22. Disadvantages of Endotracheal Intubation • Requires considerable training and experience • Requires specialized equipment • Requires direct visualization of vocal cords • Bypasses upper airway’s functionsof warming, filtering, and humidifying the inhaled air

  23. Complications of Oraltracheal Intubation • Equipment malfunction • Teeth breakage and soft tissue lacerations • Hypoxia • Esophageal intubation • Endobronchial intubation • Tension pneumothorax

  24. Visual Landmarks

  25. Hyperventilate the patient

  26. Prepare and Test Equipment

  27. Apply Sellick’s maneuver and insert laryngoscope

  28. Visualize glottis through laryngoscopy

  29. Inflate cuff, ventilate, and auscultate

  30. Confirm placement with an ETCO2 detector

  31. Secure tube

  32. Reconfirm tube placement

  33. Field Extubation • Prepare intubation equipment and suction • Confirm patient responsiveness • Suction the patient’s oropharynx • Deflate the cuff • Remove the tube upon cough or expiration • Provide supplemental oxygen as needed • Reassess the adequacy of the patient’s ventilation and oxygenation

  34. Summary • Sellick’s manuever • Necessary equipment to perform orotracheal intubation • Indications, advantages, disadvantages, and complications of orotracheal intubation • Visual landmarks • Steps to perform orotracheal intubation • Methods of assessing, confirming, and securing correct placement of an orotracheal tube • Technique for extubation

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