2. Indications: Endotracheal Intubation
• Respiratory Failure: Hypoxia, Hypercapnia,
tachypnea, or apnea ; ie. ARDS, asthma,
pulmonary edema, infection, COPD
exacerbation
• Inability to ventilate unconscious patient
• Maintenance or protection of an intact airway
• Cardiac Arrest
• Medication administration
3. Contraindications:
• Inability of patient to extend head
• Moderate to severe trauma to the cervical
spine or anterior neck
• Infection in the epiglottal area
• Mandibular fracture or trismus
• Mild hypoxia
• Uncontrolled oropharyngeal hemorrhage
• Intact tracheostomy
4. Equipment
• Laryngoscope
• Blades: curved (MacIntosh) and straight
(Miller)
• Endotracheal tubes of various sizes:
– Neonates and full term infants: no. 0 and 1
– Adult women: 7.0 mm i.d. tube
– Adult men: 8.0 to 8.5 mm i.d. tube
– Pediatric size: (age in years/4) + 4 or width of
fingernail of the fifth digit
5. Continue Equipment for ET intubation:
• Lubricant, Malleable stylet
• 10-ml syringe (to inflate ET cuff)
• Oxygen and manual bag valve mask
• Suction apparatus
• Stethoscope
• Sterile gloves and goggles
• Oropharyngeal airway
• CO2 Detector
6. How do you confirm the correct placement
of the ET Tube?
• Primary Confirmation
• Secondary Confirmation
7. Primary Confirmation By Physical
Exam
• Confirm tube placement immediately
• Listen over the epigastrium and observe the
chest wall for movement
• If stomach gurgling and no chest wall
expansion, esophagus intubated:remove ET
tube
• Reattempt intubation after reoxygenation
8. Primary Confirmation: cont.
• If chest wall rises and stomach not gurgling,
perform 5-point auscultation
• If still doubt, use laryngoscope to see the tube
passing through the vocal cords (best)
• Secure the tube
• Look for moisture condensation on the inside
of the tracheal tube (not 100%: false + with
esophageal intubations)
9. Secondary Confirmation
• End-Tidal CO2 Detectors
– Commercial device that reacts with a color change
to CO2 exhaled from the lungs: MELLO YELLOW
– Qualitative detection device indicates exhaled
CO2 indicates proper tracheal tube placement
– Absence of CO2 (unless prolonged CPR), indicates
esophageal intubation
– False+: Distended stomach, carbonated beverages
– False-: Low or no blood flow state ( as above)
11. Complications
• Hypoxia
– Long duration of procedure
– Esophageal intubation ( not visualizing vocal
cords)
– Intubation of a bronchus ( right more common)
– Failure to secure the placement
– Failure to recognize misplacement of tube
– Aspiration
– Pneumothorax
12. Complications: continued
• Trauma and adverse effects
– Broken teeth
– Oral lacerations
– Vocal cord injury
– Pharyngeal-esophageal perforation
– Short-term laryngeal edema
– Release of high levels of epinephrine and norepinephrine
stimulated by tracheal intubation:
can cause elevated blood pressure, tachycardia,
arrhythmias
