ntubation is a process where a healthcare provider inserts a tube through a person's mouth or nose, then down into their trachea (airway/windpipe). The tube keeps the trachea open so that air can get through. The tube can connect to a machine that delivers air or oxygen. RAPID SEQUENCE INTUBATION: Rapid sequence induction (RSI) is a set of actions during induction of anaesthesia in unfasted patients or patients at risk of aspiration/regurgitation of gastric contents. INDUCTIION AGENT: Induction agents (sedatives) are integral to the performance of rapid sequence intubation (RSI). They provide amnesia, blunt sympathetic responses, and can improve intubating conditions. CRICHOID PRESSURE: Cricoid pressure is applied by an assistant using the thumb and second finger; the first finger stabilizes the thumb and finger on the cricoid ring. press directly backwards at a force of 20-30 newtons against the cervical vertebrae. endotracheal tube selection Endotracheal tube selection for male is 8.0 and for female is 7.5 Formula for endotracheal tube children in paediatrics is  [(Age/4) + 4] for uncuffed tubes [(Age/4) +3.5] for cuffed tubes

1. INTUBATION
SUBMITTED BY
PANKAJ SINGH RANA
NURSE PRACTITIONER

2. INTRODUCTION
• Intubation is a procedure by which a tube is inserted in the
lungs to provide ventilation to the lungs.
• Intubation is life saving procedure.
• It help maintain airway access.

3. MOST COMMON WORDS USED DURING
INTUBATION
• RAPID SEQUENCE INTUBATION:
Rapid sequence induction (RSI) is a set of actions during induction of anaesthesia in unfasted
patients or patients at risk of aspiration/regurgitation of gastric contents.
• INDUCTIION AGENT:
Induction agents (sedatives) are integral to the performance of rapid sequence intubation (RSI). They
provide amnesia, blunt sympathetic responses, and can improve intubating conditions.
• CRICHOID PRESSURE:
Cricoid pressure is applied by an assistant using the thumb and second finger; the first finger
stabilizes the thumb and finger on the cricoid ring. press directly backwards at a force of 20-30
newtons against the cervical vertebrae.

5. INDICATION
• Airway obstruction (something caught in the airway, blocking the flow
of air).
• Cardiac arrest (sudden loss of heart function).
• Injury or trauma to your neck, abdomen or chest that affects the
airway.
• Loss of consciousness or a low level of consciousness, GCS below 7
• Preoperative
• Respiratory failure or apnea (a temporary stop in breathing).
• Risk for aspiration (breathing in an object or substance such as food,
vomit or blood).
• Shock

6. EQUIPMENT
• Intravenous access
• Hemodynamic monitoring
• Stethoscope
• Pulse oximeter
• End-tidal carbon dioxide (EtCO2) monitor
• Suction catheter attached to continuous suction
• Laryngoscope
• Endotracheal tube
• Cardiac arrest cart with resuscitation medications
• Rapid sequence intubation medications (paralytic, sedative, and/or
dissociative agent)
• Defibrillator

7. AIRWAY EVALUATION
Check for difficult airway.
• restricted cervical motion
• obesity
• facial or neck trauma
• burn

9. ENDOTRACHEAL TUBE SELECTION
• Endotracheal tube selection for male is 8.0 and
for female is 7.5
• Formula for endotracheal tube children in
paediatrics is
• [(Age/4) + 4] for uncuffed tubes
• [(Age/4) +3.5] for cuffed tubes

10. SEDATIVE
Midazolam
Ketamine
Fentanyl
Propofol
Etomidate
Succinylcholine (ultra-short acting)
Rocuronium
Vecurounium
Atracurium
MUSCLE RELAXANT
DRUGS

11. INTUBATION PROCEDURE

12. PROCEDURE OF INTUBATION
• Insert an IV needle into your arm.
• Deliver medications through the IV to put you to
sleep and prevent pain during the procedure
(anaesthesia).

13. • Place an oxygen mask over your nose and
mouth to give your body a little extra oxygen.
• Provide bag mask ventilation if
unable to achieve target
saturation .

14. • Prepare the patient by giving patient appropriate position for intubation
• (sniffing position, a combination of flexion of the neck and extension of the head)

15. • Tilt your head back
and insert a
laryngoscope into
your mouth.
• Move the tool toward
the back of your
mouth, avoiding your
teeth.
• Raise the epiglottis, a
flap of tissue that
hangs in the back of
the mouth to protect
your larynx (voice
box).

16. • Inflate ET tube

17. • Place tape on the side of your mouth or a strap around your head to keep the tracheal tube in place.

18. Confirmation of to be done by

20. INTUBATION FAILURE
Use of following in case of
intubation failure
• Laryngeal mask airway
(LMA)
• Bougie
• Cricothyrotomy tray
• Magill forceps

21. BOUGIE

23. • Magill forceps are angled
forceps used to guide a
tracheal tube into the
larynx or a nasogastric
tube into the esophagus
under direct vision.

25. COMPLICATION
• damage to the vocal cords
• Bleeding
• Infection
• Tearing or puncturing of tissue in the chest cavity that can lead to
lung collapse (tension pneumothorax)
• Injury to throat or trachea
• Injury to teeth
• Aspiration