Dr.

Muhamad Haris
House Surgeon,
Surgical Unit 2, JHL

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OBJECTIVES

 what is endotracheal intubation?
 what are the indications of intubation?
 equipment required for intubation
 technique of intubation
 confirmation of intubation
 ventilation
 complications
 extubation

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 Jawprotrusion  Neck movement  Thyromental distance  Modified Mallampati test 3 .

 Endotracheal intubation is the placement of a special tube in trachea 4 .

 To secure airway  Respiratory rate<8bpm or >35bpm  general Anesthesia  Inability to tolerate NIV  ventilatory therapy in ICU 5 .

5 mm ( plain ) 2) 1-3 yrs. 6 to 7 mm ( cuffed ) 5) adult female.5 to 3. 7 to 8 mm 6) adult male. 5 to 6 mm 4) 6-10 yrs. size of tube 1) 0-1 yrs. to 5 mm 3) 4-6 yrs. 4. 2. 8 to 9 mm  Laryngoscope  Stylet  Stethoscope  syringe  source for ventilation  Running Suction 6 .

Different sizes of cuffed and plain ETT 7 .

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Laryngoscope 9 .

Syringe to inflate cuff 10 .

suction 11 .

Raise the head by 5cm with a block or ring pillow 12 .

 Extension at atlanto-occipital joint  Flexion at neck 13 .

 hold the laryngoscpoe with LEFT hand irrespective of dominant hand  open the mouth with right hand index finger with support of thumb  introduce Laryngoscpoe from right angle of mouth  shift the tongue to left  go in  press over tongue  see epigllotis  lift ît  watch for voccal cords 14 .

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 take the tube in right hand  introduce under vision  confirm placement by auscultation  if tube is cuffed inflate the cuff with syringe 16 .

 Confirmation a) by chest expansion b) by Auscultation c) end tidal CO2/ Capnograph d) CXR  fix the tube with adhesive 17 .

 ambu's bag  anesthesia machine  ventilator 18 .

bronchospasm 19 .. rise in blood pressure . Tachycardia . Increase in secretions . Laryngospasm .

 tube in oesophagous  endobronchial intubation  trauma to teeth. pharynx and larynx  Bleeding  Disconnection. kinking of tube  Delayed Infection or tracheal stenosis 20 . blockage.

 if mouth opening restricted  anterior vocal cords  burn contracture  Webbed neck  Morbid obesity  Cervical spine injury 21 .

 Continue Bag Mask ventilation  Repositioning  Change of blade  Change of practitioner/ call for help  LMA  Fiberoptic intubating bronchoscope 22 .

Laryngeal mask airway (LMA) 23 .

It is advisable if the cause is treated  throat suction  Reflexes  Spo2  adequate respiration/ coughing  level of consciousness  Satisfactory gas exchange  extubate 24 .

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