ADVANCED AIRWAY
MANAGEMENT
Tracheal Intubation
Advantages
- Allows ventilation with up to 100% O2
- Isolates airway, preventing aspiration
- Allows suctioning of the lower airways
- Alternative route for drug administration
Limitations
- Training and experience essential
- Failed insertion, oesophageal placement
- Potential to worsen cervical cord or head injury
Attempting intubation:
Pre-oxygenate the patient
Allow 30 seconds only for each attempt
Manual in-line stabilisation of c-spine
Insert tube through larynx under direct vision
If in doubt or difficulty, re-oxygenate before further attempts
Patients are harmed by failure of oxygenation, not failure of intubation!
Equipment needed for endotracheal intubation
- A means of artificial ventilation with added oxygen prior to intubation
- Suction
- Stethoscope
- Laryngoscope
- Endotracheal tube of appropriate size
- 10ml syringe
- A method of securing the tube
- Self inflating bag with oxygen or mechanical ventilator with appropriate connectors to allow artificial ventilation following intubation
Additional equipment that may be needed for endotracheal intubation
Magills forceps
Bougie/stylette
Fine suction catheter
Confirming correct placement of a tracheal tube
Direct visualisation at laryngoscopy
Listen with stethoscope:
Bilaterally, mid-axillary line
Over the epigastrium
Symmetrical movement of the chest during ventilation
Needle Cricothyroidotomy
Indication
Failure to provide an airway by any other means
Complications
- Malposition of cannula
- Emphysema
- Haemorrhage
- Oesophageal perforation
- Hypoventilation
- Barotrauma
Surgical cricothyroidotomy
Size 6 ETT inserted via incision in cricothyroid membrane
Protects against aspiration
Risk of bleeding, infection, malposition
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