Intubation: Difference between revisions
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#Neck mobility | #Neck mobility | ||
==Laryngoscopy Grades | == Laryngoscopy Grades (Cormack & Lehane) == | ||
I | {| style="width: 500px" border="1" cellpadding="1" cellspacing="1" | ||
|- | |||
| Grade<br/> | |||
| View<br/> | |||
| Failure Rate<br/> | |||
|- | |||
III | | I<br/> | ||
| whole aperture | |||
IV | | 0%<br/> | ||
|- | |||
| IIa<br/> | |||
| ayretenoids +partial cords | |||
| 4%<br/> | |||
|- | |||
| IIb<br/> | |||
| ayretenoids only | |||
| 67%<br/> | |||
|- | |||
| III<br/> | |||
| epiglottis only | |||
| >67%<br/> | |||
|- | |||
| IV<br/> | |||
| no epiglottis | |||
| ?%<br/> | |||
|} | |||
==Nasal Intubation== | ==Nasal Intubation== |
Revision as of 16:33, 12 March 2011
Indications
- Failure to ventilate
- Failure to oxygenate
- Inability to protect airway (gag unhelpful)
- Anticipated clinical course (anticipated deterioration, transport, or impending airway compromise)
- Increased ICP (for hyperventilation)
- Combative, needing imaging
Premedication
- Lidocaine (1.5mg/kg): inc ICP, severe asthma
- Fentanyl (3mcg/kg): ischemic CAD, inc ICP, aortic dissect
- Atropine (0.02mg/kg): children <10 yrs
^consider ketamine (1.5mg/kg) in place of etomidate for induction in asthma
Difficult BVM (MOANS)
- Mask seal
- Obesity
- Aged
- No teeth
- Stiffness (resistance to ventilation)
"Remove dentures to intubate; keep them in to bag/mask ventilate"
Difficult Intubation
- Look externally (gestalt)
- Evaluate 3-3-2 rule
- Mallampati
- Obstruction
- Neck mobility
Laryngoscopy Grades (Cormack & Lehane)
Grade |
View |
Failure Rate |
I |
whole aperture | 0% |
IIa |
ayretenoids +partial cords | 4% |
IIb |
ayretenoids only | 67% |
III |
epiglottis only | >67% |
IV |
no epiglottis | ?% |
Nasal Intubation
- sniffing position (like oral ET)
- pretreat with lido, hurricaine, or 4cc nebulized lidocaine for 5 minutes
- Tube size = 1.0 mm smaller
- listen with stethoscope at end of tube (breath sounds become louder as tube approaches cords)
- when tube hits cords patient will cough, back up 1 or 2 cm. wait for beginning of inspiration, as patient begins inspiration advance 3-4 cm (tube should be 22-26cm in women, 23-28cm in men)
tips: occlude other nostril to hear better, cricoid pressure when advancing, use a small suciton catheter as a seldinger guide, precurve tube before insertion.
See Also
Air/Resus: Airway (RSI)
Air/Resus: Rapid Sequence Intubation (RSI)
Source
2/06 DONALDSON (Adapted from Rosen, Lampe)