Intubation: Difference between revisions
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==Indications== | ==Indications== | ||
1) Failure to ventilate | 1) Failure to ventilate | ||
2) Failure to oxygenate | 2) Failure to oxygenate | ||
3) Inability to protect airway (gag unhelpful) | 3) Inability to protect airway (gag unhelpful) | ||
4) Anticipated clinical course (anticipated deterioration, transport, or impending airway compromise) | 4) Anticipated clinical course (anticipated deterioration, transport, or impending airway compromise) | ||
*5) Increased ICP (for hyperventilation) | *5) Increased ICP (for hyperventilation) | ||
*6) Combative, needing imaging | *6) Combative, needing imaging | ||
==Premedication== | ==Premedication== | ||
1) Lidocaine (1.5mg/kg): inc ICP, severe asthma | 1) Lidocaine (1.5mg/kg): inc ICP, severe asthma | ||
2) Fentanyl (3mcg/kg): ischemic CAD, inc ICP, aortic dissect | 2) Fentanyl (3mcg/kg): ischemic CAD, inc ICP, aortic dissect | ||
3) Atropine (0.02mg/kg): children <10 yrs | 3) Atropine (0.02mg/kg): children <10 yrs | ||
*consider ketamine (1.5mg/kg) in place of etomidate for induction in asthma | *consider ketamine (1.5mg/kg) in place of etomidate for induction in asthma | ||
==Difficult BVM (MOANS)== | ==Difficult BVM (MOANS)== | ||
Mask seal | Mask seal | ||
Obesity | Obesity | ||
Aged | Aged | ||
No teeth | No teeth | ||
Stiffness (resistance to ventilation) | Stiffness (resistance to ventilation) | ||
"Remove dentures to intubate; keep them in to bag/mask ventilate" | "Remove dentures to intubate; keep them in to bag/mask ventilate" | ||
==Difficult Intubation== | ==Difficult Intubation== | ||
Look externally (gestalt) | Look externally (gestalt) | ||
Evaluate 3-3-2 rule | Evaluate 3-3-2 rule | ||
Mallampati | Mallampati | ||
Obstruction | Obstruction | ||
Neck mobility | Neck mobility | ||
==Laryngoscopy Grades (Cormack & Lehane)== | ==Laryngoscopy Grades (Cormack & Lehane)== | ||
I whole aperture (0%) | I whole aperture (0%) | ||
II.a ayretenoids +partial cords (4%) | II.a ayretenoids +partial cords (4%) | ||
II.b ayretenoids only (67%) | II.b ayretenoids only (67%) | ||
III epiglottis only (>67%) | III epiglottis only (>67%) | ||
IV no epiglottis (?%) | IV no epiglottis (?%) | ||
*(failure rate) | *(failure rate) | ||
==Nasal Intubation== | ==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== | ==See Also== | ||
Air/Resus: Airway (RSI) | Air/Resus: Airway (RSI) | ||
Air/Resus: Rapid Sequence Intubation (RSI) | Air/Resus: Rapid Sequence Intubation (RSI) | ||
==Source == | ==Source == | ||
2/06 DONALDSON (Adapted from Rosen, Lampe) | 2/06 DONALDSON (Adapted from Rosen, Lampe) | ||
[[Category:Airway/Resus]] | [[Category:Airway/Resus]] | ||
Revision as of 08:25, 2 March 2011
Indications
1) Failure to ventilate 2) Failure to oxygenate 3) Inability to protect airway (gag unhelpful) 4) Anticipated clinical course (anticipated deterioration, transport, or impending airway compromise)
- 5) Increased ICP (for hyperventilation)
- 6) Combative, needing imaging
Premedication
1) Lidocaine (1.5mg/kg): inc ICP, severe asthma 2) Fentanyl (3mcg/kg): ischemic CAD, inc ICP, aortic dissect 3) 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)
I whole aperture (0%) II.a ayretenoids +partial cords (4%) II.b ayretenoids only (67%) III epiglottis only (>67%) IV no epiglottis (?%)
- (failure rate)
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)