Endotracheal Intubation
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ENDOTRACHEAL INTUBATION
Presented by-
Indrakshi Basu
1st year, M.Sc. Nursing
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INTRODUCTION
An emergent critical care procedure.
Needs advanced nursing Practice.
Ensure AIRWAY Patency.
Done by physicians, assisted by nursing personnel.
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RELATED ANATOMY AND PHYSIOLOGY
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ENDOTRACHEAL TUBE PLACEMENT
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DEFINITION
• Insertion of a hollow, slender, long tube into trachea bypassing the upper airway and laryngeal strictures to create an alternative airway solution.
• Distal tip of tube situates just above carina.
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INDICATION
Acute Respiratory
Failure
Pulmonary Obstructive
Disorder
Trauma & Injury
Structural Anomaly
Neuromuscular Disorder
Aspiration prophylaxis
Post-operative
Anaphylaxis
Need Airway Protection
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CONTRAINDICATION
•Airway Trauma
•Cervical Spine Injury
•Mallampati classification (iii / iv)
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MALLAMPATI CLASSIFICATION
DIFFICULT INTUBATION
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DESCRIPTION
No anticipated difficulty• GRADE 1: Visualised soft palate,
fauces, uvuala, tonsillar pillar.
• GRADE 2: Visualised soft palate,
fauces,uvuala.
Anticipated difficulty• GRADE 3(Moderate): Visualised soft palate, base
of uvuala.• GRADE 4(Severe): No soft palate visualised.
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TYPES
• 1. orotracheal intubation.• 2. Nasotracheal intubation.
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TECHNIQUES
CURVED BLADE
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TECHNIQUE
STRAIGHT BLADE
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SIZE of E. T. TUBE
Distance between lips and location in mid trachea of distal end (in cm)is the size of ET tube.
Premature: 2.5 mm Full term: 3.0 mm Adult (male): 8 to 8.5 mm Adult (female): 7.5mm
Internal diameter
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ARTICLE PREPARATION Tray set up. Uninterrupted source of oxygen. Medication.
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MEDICATIONS
KETAMINE 1.5 -2 mg/kg. TBW. ETOMEDITE 0.3-0.4 mg/kg TBW. MIDAZOLAM 0.1- 0.3 mg/kg TBW. PROPOFOL 1-2.5 mg/kg TBW + (0.4* TBW). FENTANYL 2-10 mcg/kg TBW.
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Uncuffed E.T. tube for neonatesLaryngeal mask for difficult intubation
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RESUSCITATION TROLLY
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GENERAL CONSIDERATION
Privacy and comfort. Safety. Consent. Assembling resources tactfully. Asepsis. Communication aid of client.
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PROCEDURE
• J:\New folder\Endotracheal intubation A3chem Multimedia.mp4
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AFTER CARE OF CLIENT
Tidy up . X- ray report collection. Documentation. DOPE-Displacement of tube, tube obstruction
Pneumothorax, equipment failure. Suction. Cuff Pressure measurement. Reporting as vulnerable client. VAP Bundle. * *
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AFTER CARE OF ARTICLE
Ambu bag in Closed zip bag.
Papers
Plastic items
Body waste
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COMPLICATIONS
During intubation
Spinal cord injury
Aspiration
Dental damage
Laceraton & perforation
Tube goes
cranial vault
Epistaxis
Delayed resuscitation
Corneal abrasion
Cartilage dislocatio
n
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CARDIOVASCULAR COMPLICATIONS
* PSVT• VT• BRADYR
HYTHMIA
HYPERTENSIONHYPOTENSION
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TUBE RELATED COMPLICATION
kink & block Dislodgement
Advancement in bronchus
Mechanical damage of upper airway
structure
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POST INTUBATIONCOMPLICATION
Laryngospasm Laryngeal edema
Dysphonia Hemorrhage
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Principles in the procedure?
• SPECIFIC PRINCIPLES: Microbiology, Anatomy & Physiology, Body
mechanics, Psychology, Pharmacology, skilled practice hand, Radiology…..
• GENERAL PRINCIPLES OF NURSING: Safety, therapeutic effectiveness, economy of
resources….
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Any quiry????
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Thank you