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Respiratory & Airway Part Six

Laryngoscope: used to move the tongue and epiglottis out of the way of the vocal cords. Made up of two pieces

  1. Handle – holds the batteries for the light
  2. Blade comes in sizes 0 (newborn) to 4 (adult)
  • Curved blade – Macintosh, leaves more room to visualize glottic opening, less gagging due to position – insert blade into vallecula
  • Straight blade – Miller, Wisconsin, Flagg, goes under the epiglottis

ET Tube – flexible translucent tube open at both ends.

  • Proximal end is standard 15mm adapter to connect various devices to deliver positive pressure ventilation
  • Distal end is beveled to go between the vocal cords
  • Balloon cuff to occlude the remainder of the tracheal lumen, Use syringe to Pediatric has no cuff.
  • Marked with measurements to help ensure correct positioning
  • 5 to 9 mm across and 12-32 cm long
  • Average size 7.5 – 8 for women 8-8.5 for men
  • Right size is really important
    Stylet – semi-rigid plastic coated wire to help form the tube for easier placement
    Tube Holder/Tie down – or use tape to hold in place

Intubation Procedure:

  1. Measure and select the right size tube
  2. Curve stylus as needed
  3. Tip of curved blade is advanced into the vallecula. Straight blade is inserted under the epiglottis
  4. Never use the teeth as a fulcrum
  5. When you can see the vocal cords, place the ET tube through the opening
  6. Use the syringe to inflate the cuff, and then remove syringe immediately
  7. Secure the tube with a holder/bite block or tape
    Once the tube is in place, there is no need to synchronize ventilation with chest
    compressions

Complications

  • Hypoxia – can take too long, attempt no longer than 30 seconds
  • Injury to teeth and tissue
  • Misplaced tube in esophagus, right bronchi
  • Difficulty – short fat necks, small receding chins, beards, large tongues, facial/neck injury/burns, fractured mandible laryngeal injury

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