Intubation: Difference between revisions
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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 | ||
| Line 11: | Line 16: | ||
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 | ||
Revision as of 08:26, 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)