This an Presentation of ENDOTRACHEAL INTUBATION. Which Consist of Definition, Indication , Contra-indication, Equipments, Techniques, Procedure and Compliction.

2. SYNOPSIS
 INTRODUCTION
 DEFINITION
 ARTICLES
 PURPOSE
 POSITION
 PARTS
 TYPES
 USES
 FUNCTION
 SIZE
 ORAL ENDOTRACHEAL INTUBATION [PROCEDURE,ADVANTAGE,DISADVANTAGE]
 NASAL ENDOTRACHEAL INTUBATION [PROCEDURE,ADVANTAGE,DISADVANTAGE]
 COMPLICATION

3. INTRODUCTION
 Tube into trachea to provide ventilation using BVM or
ventilator.
 Sized based upon inside diameter [ID] in mm
 Length increased with increased ID [cm making long
length]
 Cuffed, uncuffed.

4. DEFINITION
Endotracheal intubation is the placement
of a flexible plastic tube into the trachea
to maintain an open airway on the serve
as a conduit through which to administer
lertain drugs.

5. ARTICLES
 Sand bag /towel roll
 Suction apparatus with tubing
 Suction catheter
 Ambu bag and mask
 Oxygen source and tubing
 Laryngoscope with appropriate size blade
 magill’s forceps
 Endotracheal tube of appropriate size
 Stylette
 Xylocaine jelly , plastic syringe, oral airway, cotton tape,
gloves, face mas.

6. PURPOSE
To administer oxygen
To remove secretions
To ventilate the lungs
To establish and maintain airway
To treat acute respiratory failure
and persistent hypoxia.

7. POSITION
Position patient in supine position with
head extended by keeping sand bag or
towel roll under the neck.

8. PARTS
It consist of the following parts;-
 Beveled tips
 Murphy eye
 Cuff
 Connector
 Pilot ballon
 valve

9. TYPES
TYPE OF ENDOTRACHEAL TUBE INCLUDE;-
 Oral [or] nasal
 Cuffed [or] uncuffed
 Performed [eg; RAE [ring,adair,elwn
tube]
 Rainforced tubes
 Double lumen endobronchial tube

10. USES
Increase patient safety
They maintain an open airway
Minimizes the likelihood of pulmonary
aspiration of blood, stomach contents.
Facilitates administration of supplemental
oxygen.
Allows the anaesthetist to ventilate the
patient when necessary.

11. FUNCTION
It provides a passage for gases to flow
between a patients lungs and an
anaesthesia breathing system.
It allows one to provide positive pressure
ventilation.
It protects the lungs from contamination
from gastric contents and
nasopharyngeal matter such as blood.

12. SIZE
o Average size for female – 7.5 to
8.0mm
o Average sizefor male – 8.5 to 9.00 mm

13. ORAL ENDOTRACHEAL INTUBATION
The ET tube is passed through the mouth
and vocal cords and into the trachea with
the aid of a laryngoscope or
bronchoscope.

14. PROCEDURE FOR ORAL INTUBATION
 The patient is placed in a sniffing position to align the
airway structures.
 If the procedure is performed a topical anesthetic and or
premedication with sedative may be used so that the
patient better tolerates the procedures.
 Before the procedure is performed, the patient is
hyperoxygenated and hyperventilation with 100% oxygen by
use of a bag valve device with a face mask
 The proper sized tube is chosen
 After the tube is selected, the cuff on the ballon is inflated
to check for proper functioning and/or any leak.

15. Cont……..
 A stylet is used to stiffen the ETT and lubricant. The
laryngoscope is attached to appropriate size and type
of blade [straight or curved].
 The straight blades elevate the epoglottis anteriorly
to expose the vocal cords.
 The tip of the curved blads fits into the vallecula
when upwards traction is placed on the laryngoscope
the epiglottis is displaced anteriorly.
 The person doing the intubation inserts the
laryngoscope into the mouth the visualize the vocal
cords.

16. Cont….
 Excess secretion and/or vomitus in suctioned to
facilitate visualization of the vocal cords the tonsil
suction tip is very efficient in removing the secretion.
 The ET is inserted 5 to 6 cm beyond the vocal cords,
and the cuff is inflated
 The procedure should be performed with in 30 sec.
 If the intubation difficult the patient should be
manually ventilated between intubation attempts.
 Frequently the patient requires ET suctioning for
removal of excess secretions immediately after
intubation.

17. CONT….
 Placement of the ETT is verfied by the movement of
air in all and out of the tube observation of bilateral
chest expansion with inspiration and ausculation of
bilateral breath sounds while the patient in ventilated
with a bag valve device.
 Another method for verifying the placement is end
tibal carbodioxide monitoring. Itf the tube is in the
trachea carbondioxide is latected in enhaled air.
 After intubation a portable chest x-rays study in
always performed for verification of the tube
placement the tip of the ETT should ne approximately
2-5 cm above the carina.

18. ADVANTAGE
Easily and quickly performed
Larger tube facilities suction and
procedures. Such as bronchoscopy.
Less kinking of tube.

19. DISADVANTAGE
Not recommended in patients with
suspected cervical injury.
Mount care more difficult to perform.
May increase salivation
May cause irritation and ulceration of the
mouth.

20. NASAL ENDOTRACHEAL INTUBATION
A endotracheal tube is placed blindingly
[eg;- without visualizing the larynx ]
through the nose, nasopharynx and vocal
cords.

21. PROCEDURE FORNASOTRACHEAL
TUBE
A nasotracheal, ETT is usually better
tolerated in an alert patient and may easier
to stabilize
In nasotracheal intubation, the ETT is usually
inseted through the woses and men passed
blinding into the glotts during inspiration.
The blind intubation method is performed in
the alert patient who is capable of
spontaneous respirarion.

22. CONT….
The nose and pharynx are anesthetized
before the procedure .
Nasotracheal intubation can also be
performed through direct visulization.
In this method, practitioners may use a
laryngoscope and magill forceps or
fiberoptic bronchoscopy during the
intubation.

23. ADVANTAGES
Greater patient comfort and better
Better mouth care possible
Facilities swallowing of secrations
Can administer small amount
Oral liquids of patient able to swallow

24. DISADVANTAGE
More difficult to perform
Not able to administer for the nasal
damage patient.
May cause nasal hemorrhage and
sinusitis.
Secration removal more difficult because
of smaller tube diameter and longer tube
length.

25. COMPLICATION
 Several complication may occur result of oral
endotracheal [or] nasotracheal intubation.
 Complication include
 Hypoxia
 Dysrhythmias
 Aspiration
 Larynogospasam
 Bronchospasm
 Trauma to airway structures
 Broken teeth or dentures