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Intubation Steps

Airway Care

Intubation Step:1 Position Patient Head in sniffing position slight hyperextension
Intubation Step:2 Adequately hyperoxygenate (resuscitation bag with 100% for 2 minutes
Intubation Step:3 Hold laryngoscope in left hand ET Tube in right hand
Intubation Step:4 Insert blade down the right side of the mouth, sweep tongue to the left.
Intubation Step:5 Advance blade, lift epiglottis visualize vocalcords, (curve blade tip) = vallecula (straight blade tip) = epiglottis have suction available
Intubation Step:6 Cricord Pressure = (Selleck Maneuver) is indicated if the larynx is in an anterior location
Intubation Step:7 Insert tube, inflate cuff, assess tube position, ventilate, and oxygenate
Minimal Occluding Volume (MOV) technique used to inflate cuff = 20-25 mmHg/25-30 cmH20 listen for air leak as cuff is inflated during positive pressure ventilation: STOP inflating at minimum volume necessary to eliminate air leak via trach or ET Tube
Minimal Leak Technique (MLT) slowly inject air into the cuff during positive pressure inspiration until leak STOPS; A small amount of air is removed to allow a slight leak during peak inspiration. Remove the small amount to PREVENT aspiration
Assessment Of Tube Position Notice Sequence 1. Inspection (look for bilateral chest expansion during inspiration) 2. Auscultation (breath sounds should be heard bilateral) 3. Capnography (CO2 Detector) 4. Chest X-ray ( tip of tube 2cm or 1 in ABOVE carina or at aortic knob/notch
Tube Maintenance Suctioning Maintain patency
Tube Maintenance Humidification * Prevent dehydration of tissue (100% Humidity @ 37.C) * Best way to prevent obstruction
Tube Maintenance Cuff Pressure *Minimal leak *Minimal occluding volume *Use high volume/low pressure cuff =to or< 20mmHg)
Created by: sukarieh