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Endotracheal Intubation

Endotracheal Intubation

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Published by Darell M. Book

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Published by: Darell M. Book on Feb 28, 2010
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12/10/2012

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ENDOTRACHEAL INTUBATION
PURPOSE:
Endotracheal intubation is performed to establish and maintain a patent airway,facilitate oxygenation and ventilation, reduce the risk of aspiration, and assist with theclearance of secretions.
NOTE:
This procedure should be performed only by physicians, advanced practice nurses,and other health care professionals (including critical care nurses) with additionalknowledge, skills and demonstrated competence per professional licensure or institutional standard.
PREREQUISITE NURSING KNOWLEDGE
INDICATIONS:
Upper airway obstruction (e.g., secondary to swelling, trauma, tumor, bleeding)
Apnea
Ineffective clearance of secretions (e.g. Inability to adequate maintain airway)
High risk of aspiration
Respiratory distress
WHAT TO DO:
Pulse oximetry should be used during intubation so that oxygen desaturation can bequickly detected.
Pre-oxygenation with 100% oxygen using a bag-valve-mask device with a tight-fittingface mask should be performed for 3 to 5 minutes before intubation.
Intubation attempts should take no longer than 15 to 30 seconds.
Applying cricoid pressure (Sellick maneuver) may decrease the incidence of pulmonary aspiration and gastric distention. This procedure is accomplished byapplying firm, downward pressure on the cricoid ring, pushing the vocal cordsdownward so they are more easily visualized. Once begun, cricoid pressure must bemaintained until intubation is completed.
EQUIPMENT:
Personal protective equipment
Endotracheal tube with intact cuff and 15 mm connector 
( Adult female 7.5 to 8.0 mmtube, adult male 8.0 to 9.0-mm tube)
Laryngoscope handle with fresh batteries
Laryngoscope blades (straight or curved)
Spare bulb for laryngoscope blades
Flexible stylet
Self-inflating resuscitation bag with mask connected to 100% oxygen
Oxygen source and connecting tubes
Non-sterile gloves
Luer-tip 10 ml syringe for cuff inflation
Water-soluble lubricant
Rigid pharyngeal suction-tip catheter 
Suction apparatus
Suction catheter 
ET Tube tape (adhesive ( 6 to 8 in long)
Stethoscope
 
Sedating or paralyzing medications
Forceps to remove foreign bodies
Local anesthesia
PARTS OF A LARYNGOSCOPE
PARTS OF AN ENDOTRACHEAL TUBE
ENDOTRACHEAL INTUBATION
 
CHEST TUBE/THORACOSTOMY
INDICATIONS:
Drainage of hemothorax, or large pleural effusion of any cause
Drainage of large pneumothorax (greater than 25%)
Prophylactic placement of chest tubes in a patient with suspected chest traumabefore transport to specialized trauma center 
Flail chest segment requiring ventilator support, severe pulmonary contusion witheffusion
MATERIALS
Chest tube with or without trocar or catheter 
Chest tube suction unit tubing, suction machine
Chest tube tray to include scalpel blade and handle, large Kelly clamps, needle driver,scissors
Packet of 0 or 1.0 silk suture on a curved needle
Tape, gauze
2% lidocaine with epinephrine, 20 cc syringe, 23-gauge needle for infiltration
Sterile prep solution; mask, gown and gloves
CHEST TUBE INSERTION
Size of Chest Tube
Adult or TeenMale28-32 Fr Adult or TeenFemale28 Fr Child18 FNewborn12-14 FStep 1: Incisingthe chest wallStep 2: Openingthe incision with aKelly clampStep 3: Using aKelly clamp toguide insertion of chest tubeStep 4: Inserting achest tube

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