optional, aemt. course objectives describe sellick’s maneuver and the use of cricoid pressure...
TRANSCRIPT
Optional, AEMT
Course ObjectivesDescribe Sellick’s maneuver and the use of
cricoid pressure during intubation.Describe the necessary equipment needed to
perform orotracheal intubation.Describe the indications, advantages,
disadvantages, and complications of orotracheal intubation.
Describe the visual landmarks for direct laryngoscopy.
Course ObjectivesDescribe steps to perform orotracheal
intubation.Describe the methods of assessing,
confirming, and securing correct placement of an orotracheal tube.
Describe the technique for extubation.
Sellick’s ManeuverHelps prevent regurgitation and reduces gastric
distention.Locate the cricoid cartilage by palpating the
thyroid cartilage and the feel the depression just below it (cricothyroid membrane).
Using your thumb and index finger of one hand, apply pressure to the anterior and lateral aspects of the cricoid cartilage just next to the midline.
See picture on next slide.
Sellick’s Maneuver
Airway Before Applying Sellick’s
Airway with Sellick’s Applied (Note compression on the esophagus.)
Oraltracheal Intubation EquipmentLaryngoscope handle and bladeEndotracheal tube10 ml syringeStyletBVMSuction deviceBite blockMagill forcepsTape or tube-holding device
Laryngoscope Blades
Engaging Laryngoscope Blade and Handle
Activating Laryngoscope Light Source
Placement of Macintosh Blade into Vallecula
Placement of Miller Blade under Epiglottis
Endotracheal Tube5.0 mm-9.0 mm (cuffed)Distal end has a beveled
tip for smooth movement through airway passages.
Length ranges from 12cm-32cm.
Typical size for an average adult male is 7.5-8.5 mm
Typical size for an average adult female is 7.0-8.0 mm
Tube and Syringe
Tube, Stylet, and Syringe, Unassembled
Tube, Stylet, and Syringe, Assembled for Intubation
Magill Foreceps
Tube-Holding Device
Oraltracheal Intubation Indicators
Respiratory or cardiac arrest Unconsciousness Risk of aspiration Obstruction due to foreign bodies,
trauma, burns, or anaphylaxis
Respiratory extremis due to disease Pneumothorax, hemothorax,
hemopneumothorax with respiratory difficulty
Advantages of Oraltracheal Intubation
Isolates trachea and permitscomplete control of airway
Impedes gastric distention Eliminates need to maintain a mask seal Offers direct route for suctioning Permits administration of some medications
Disadvantages of Endotracheal Intubation
Requires considerable training and experience
Requires specialized equipment Requires direct visualization of vocal cords Bypasses upper airway’s functions
of warming, filtering, and humidifying the inhaled air
Complications of Oraltracheal Intubation
Equipment malfunction Teeth breakage and soft tissue lacerations Hypoxia Esophageal intubation Endobronchial intubation Tension pneumothorax
Visual Landmarks
Hyperventilate the patient
Prepare and Test Equipment
Apply Sellick’s maneuver and insert laryngoscope
Visualize glottis through laryngoscopy
Inflate cuff, ventilate, and auscultate
Confirm placement with an ETCO2 detector
Secure tube
Reconfirm tube placement
Field ExtubationPrepare intubation equipment and suctionConfirm patient responsivenessSuction the patient’s oropharynxDeflate the cuffRemove the tube upon cough or expirationProvide supplemental oxygen as neededReassess the adequacy of the patient’s
ventilation and oxygenation
SummarySellick’s manueverNecessary equipment to perform orotracheal
intubationIndications, advantages, disadvantages, and
complications of orotracheal intubationVisual landmarksSteps to perform orotracheal intubationMethods of assessing, confirming, and
securing correct placement of an orotracheal tube
Technique for extubation