Orotracheal Intubation: Basic Technique

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  • Failure to oxygenate adequately.
  • Failure to ventilate adequately.
  • Failure of or need for airway maintenance or protection.
  • Expected need for intubation based on progression of underlying physiologic process.
  • Do Not Resuscitate (DNR)/Do Not Intubate (DNI) orders
  • Partial tracheal transection
  • Difficult airway (relative)
  • Equipment for universal precautions (mask, gloves, etc.) **UNIVERSAL PRECAUTIONS**
  • Standard direct laryngoscope
    • Laryngoscope blades
    • Laryngoscope handle with batteries
  • Endotracheal tubes (ETTs) and accessories
    • Endotracheal tubes, variable sizes
    • Malleable ETT stylet
    • 10-mL syringe
    • ETT tape or commercial ETT holder
  • Basic airway equipment
    • Bag and mask ventilation device
    • Oropharyngeal and/or nasopharyngeal airways
    • Oxygen source and tubing
  • Sedative and neuromuscular blocking agents
  • Water-based lubricant (i.e., Surgilube)
  • Yankauer suction catheter and tubing
  • General resuscitation equipment
    • Peripheral IV (in place)
    • Cardiac monitor
    • Oxygen saturation probe
    • Blood pressure cuff
  • End-tidal CO2 detector
  • Rescue devices
    • Laryngeal mask airway or laryngeal tube
    • Intubating stylet (Frova or bougie)
  • Ventilator
  • Oral cavity and oropharynx
    • During laryngoscopy, the blade slides along the right side of the tongue in the perilingual gutter.
    • The tongue is move leftward and upward into the floor of the mouth and mandibular fossa to expose the larynx.
  • Larynx.
    • The small space between the epiglottis and base of the tongue is the vallecula. Curved laryngoscope blades are designed to be placed in this recess. Straight blades should be placed posterior to the epiglottis.
  • Trachea
    • The tip of a correctly positioned ETT should rest midway between the inferior border of the cricoid ring and the trachea.
    • The average tracheal diameter is 10 to 12 mm and can accommodate an 8.0 ETT.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Confirm tube placement.
  • Secure the tube.
  • Obtain a chest radiograph.
  • Insert a nasogastric or orogastric tube.
  • Provide sedation and pain control.
  • Obtain an arterial blood gas analysis.
  • Unrecognized esophageal intubation
  • Main-stem bronchus intubation
  • Dental, pharyngeal, and airway trauma
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