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Endotracheal intubation

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Endotracheal intubation

Endotracheal intubation

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  • 1. ENDOTRACHEAL INTUBATION TARUN YADAV
  • 2. Indication for endotracheal intubation 1) For supporting ventilation in patient with some pathologic : Upper airway obstruction disease : Respiratory : Loss of failure conciousness
  • 3.  Indication for endotracheal intubation (con’t) 2) For supporting ventilation during general anesthesia Type of surgery : Operative site near the airway : Abdominal or thoracic surgery
  • 4. Indication for endotracheal intubation (con’t) : Prone or lateral position : Long period of surgery Patient has risk of pulmonary aspiration Difficult mask ventilation  
  • 5. ANATOMY OF AIRWAY
  • 6. AIRWAY ASSESSMENTS 1) Condition that associated with difficult intubation : Congenital anomalies ---> Pierre Robin syndrome , Dow n’s syndrome : Infection in airway--> Retropharyngeal abscess, Epi glottitis : Tumor in oral cavity or larynx
  • 7. AIRWAY ASSESSMENT 1) Condition that associated with difficult intubation (con’t) : Enlarge thyroid gland trachea shift to lateral or compressed tr acheal lumen
  • 8. AIRWAY ASSESSMENT 1) Condition that associated with : Maxillofacial ,cervical or difficult intubation (con’t) laryngeal trauma : Temperomandibular joint dysfunction : Burn scar at face and neck
  • 9. AIRWAY ASSESSMENT 2) Interincisor gap : normal -> more than 3 cms
  • 10. AIRWAY ASSESSMENT 3) Mallampati classification: Class 3,4 -> Soft may be difficult intubation palate Uvula
  • 11. AIRWAY ASSESSMENT Laryngoscopic view grade 3,4 -> risk for difficult intubation
  • 12. AIRWAY ASSESSMENT 4) Thyromental distance : more than 6 cms
  • 13. AIRWAY ASSESSMENT 5) Flexion and extension of neck
  • 14. AIRWAY ASSESSMENT 6) Movement of temperomandibular joint (T MJ) Grin
  • 15. Equipment preparation
  • 16. 1) Laryngoscope : handle and blade
  • 17. LARYNGOSCOPIC BLADE Macintosh (curved) and Miller (straight) blade Adult : Macintosh blade, small children : Miller blade Miller blade Macintosh blade
  • 18. 2) Endotracheal tube
  • 19. Endotracheal tube 1) Size of endotracheal tube : internal diameter (ID) Female Male: ID 8.0 mms . : ID 7.5 mms New born - 3 months : ID 3.0 mms 3-9 months : ID 3.5 mms 9-18 months : ID 4.0 mms
  • 20. 2) Material : Red rubber or PVC 3) Endotracheal tube cuff High volumeLow volume Low pressure cuff pressure cuf High
  • 21. 4) Bevel 5) Murphy’s eye
  • 22. 6) Depth of endotracheal tube : Midtrachea or below vocal cord ~ 2 cms Adult -> Male = 23 cms ,Female = 21 cms Children Oral endotracheal tube = (Age/2) + 12 (cm)
  • 23. 7) Tube markings Z-79 Disposible (Do not reuse) Oral/ Nasal Radiopaque marker
  • 24. 3) Other equipments 3.1 Style t
  • 25. 3.2 Oropharyngeal or nasopharyngeal airway Oral airway Nasal airway
  • 26. 3.3) Suction catheter 3.4) Slip joint
  • 27. 3.5) Face mask and self inflating bag 3.6) Magill forcep
  • 28. 3.7) Syringe 3.8) Lubricating jelly 3.9) Plaster for strap endotracheal tube 4. Monitoring success of endotracheal intubation 4.1) Stethoscope 4.2) Endtidal - CO2 4.3) Pulse oximeter
  • 29. Sniffing position Flexion at lower cervical spine Extension at
  • 30. Sniffing position
  • 31. Steps of oroendotracheal intubation
  • 32. Steps of oroendotracheal intubation
  • 33. Steps of oroendotracheal intubation Vareculla
  • 34. Steps of oroendotracheal intubation
  • 35. Steps of oroendotracheal intubation
  • 36. Nasoendotracheal intubation
  • 37. Nasoendotracheal intubation Advantage 1) Comfortable for prolong intubation in postoperative per iod 2) Suitable for oral surgery : tonsillectomy , mandible surger y 3) For blind nasal intubation 4) Can take oral feeding 5) Resist for kinking and
  • 38. Disadvantage 1) Trauma to nasal mucosa 2) Risk for sinusitis in prolong intubation 3) Risk for bacteremia 4) Smaller diameter than oral route -> difficult for
  • 39. Contraindication for nasoendotracheal intubation 1) Fracture base of skull 2) Coagulopathy 3) Nasal cavity obstruction 4) Retropharyngeal abscess
  • 40. Complication of endotracheal intubation 1) During intubation : Trauma to lip, tongue or teeth : Hypertension and tachycardia or arrhythmia : Pulmonary aspiration : Laryngospasm
  • 41. Complication of endotracheal intubation (C on’t)During intubation 1) : Laryngeal edema : Arytenoid dislocation -> hoarseness : Increased intracranial pressure : Spinal cord trauma in
  • 42. Complication of endotracheal intubation(Con’t) 2) During remained intubation : Obstruction from klinking , secretion or overinflation of cuff : Accidental extubation or endobronchial intubation : Disconnection from breathing circuit
  • 43. Complication of endotracheal intubation(Con’t) 2) During remained intubation : Pulmonary aspiration : Lib or nasal ulcer in case with prolong period of intu bation : Sinusitis or otitis in case
  • 44. Complication of endotracheal intubation(Con’t) 3) During extubation Laryngospasm Pulmonary aspiration Edema of upper airway
  • 45. Complication of endotracheal intubation(Con’t) 4) After extubation Sore throat Hoarseness Tracheal stenosis (Prolong intubation)

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