Intubation Endotracheal

Procedure Guidelines

9.15 INTUBATION (ENDOTRACHEAL)

INDICATIONS:

• Respiratory or cardiac arrest.
• Glasgow Coma Scale of 8 or less.
• Decreased minute volume.
• Possible airway obstruction.

EQUIPMENT:

• Laryngoscope handle with appropriate size blade.
• Proper size endotracheal tube.
• Water soluble lubrication gel, (lubricate distal end of tube at cuff).
• 10 cc syringe, (check cuff for patency).
• Stylet, (insert into ET tube).
• Tape or endotracheal securing device.
• Proper size oral pharyngeal airway.
• BVM.
• Suction.
• Stethoscope.

PROCEDURE:

• If C-spine injury suspected, maintain cervical alignment and apply C-collar.
• Pre-oxygenate the patient before intubation procedure.
• Attach proper blade to laryngoscope handle and check light.
• Grasp laryngoscope handle in left hand.
• Grasp ET tube in right hand.
• If CPR is in progress, stop CPR but no more than 20 seconds. Maximum interruption of ventilations should not exceed 30 seconds.
• Remove all foreign objects, such as dentures, oral pharyngeal airways, etc. and suction the patient's airway if needed.
• Insert the blade into the right side of the patient's mouth sweeping the tongue to the left side.
• Visualize the vocal cords without pressure on the teeth.
• Insert the endotracheal tube until the cuff passes the vocal cords. (Insert far enough so that balloon port tubing is even with lips.)
• Remove the laryngoscope blade.
• Inflate the endotracheal cuff with the syringe with 5 - 10 cc of air and remove the syringe from inflation valve.
• Attach EtCO2 sensor to obtain wave-form Capnography.
• Ventilate the patient with a BVM and watch for chest rise. Listen to abdomen to ensure that an esophageal intubation has not been done. Listen for bilateral breath sounds.

If abdominal sounds are heard, deflate the endotracheal cuff and remove the endotracheal tube immediately. Ventilate the patient and attempt intubation again.

If lung sounds are unequal, deflate the endotracheal cuff and reposition the endotracheal tube. Inflate endotracheal cuff and reassess lung sounds. If lung sounds are still unequal, assess the patient for Pneumothorax, (simple or tension).

• Ventilate patient per current guidelines.
• Resume CPR, (if applicable).

SECURE:

• Use endotracheal securing device and secure endotracheal tube in place noting depth of tube.
• Measure and place a c-collar, to limit head movement.
• Secure head with head bed or restrain to spine board.
• Upon confirmation of successful endotracheal intubation (positive wave form), print a strip and document the initial reading on the abbreviated report.
• Continue ventilations.

DOCUMENTATION:

• Upon confirmation of successful endotracheal intubation (positive wave form), print a strip and document the initial reading on the abbreviated report.
• Document any airway or pharmacologic interventions based on capnography readings.
• Upon arrival to the emergency department and after transferring the patient to the hospital’s bed/gurney; obtain a second strip demonstrating a continued positive wave form.
• Attach both strips to the completed run report. A code summary should accompany all cardiac arrest reports.