2. Decision to Intubate
1) Failure to maintain or protect the
airway
2) failure of ventilation or oxygenation
3) the patient’s anticipated clinical
course and likelihood of
deterioration
3.
4. Administration of a potent sedative
(induction) agent and an NMBA without
interposed assisted ventilation
positive-pressure ventilation
air to pass into the stomach
gastric distention
risk of regurgitation & aspiration
5. Requires preoxygenation phase
permits pharmacologic control of the
physiologic responses to
laryngoscopy and
intubation, mitigating potential
adverse effects
Increase ICP
sympathetic discharge
6.
7. Preparation
assessed for intubation difficulty
determining dosages and sequence
of drugs, tube size, and laryngoscope
type, blade and size
continuous cardiac monitoring and
pulse oximetry
≥1 good-quality IV lines
Redundancy is always desirable in
case of equipment or IV access
failure.
9. Preoxygenation
100% oxygen for 3 minutes of
normal, tidal volume breathing
normal, healthy adult establishes an
adequate oxygen reservoir to permit
8 minutes of apnea before oxygen
desaturation to less than 90% occurs
“no bagging”
time is insufficient
8 vital capacity breaths using high-flow
oxygen
10. Pretreatment
drugs are before administration of
the succinylcholine & induction agent
mitigate the effects of laryngoscopy
and intubation on the patient’s
presenting or comorbid conditions
Intubation
sympathetic discharge
elevation of ICP
reactive bronchospasm
Bradycardia: children
12. Paralysis with Induction
rapid IV push
immediately followed by rapid
administration of intubating dose of
NMBA
wait 45 s from the time the
succinylcholine is given to allow
sufficient paralysis to occur
16. Positioning
The patient should be positioned for
intubation as consciousness is lost.
Sniffing position: head
extension, neck flexion
17. Positioning
Sellick’s maneuver
application of firm backward-directed
pressure over the cricoid cartilage
minimize the risk of passive regurgitation
and, hence, aspiration
after administration of the induction
agent and NMBA BMV should not
be initiated unless O2 sat ≤ 90%
18. Placement of Tube
assessed most easily by moving the
mandible to test for absence of
muscle tone
O2 sat is approaching 90%, the pt
may be ventilated
When BMV is performed, Sellick’s
maneuver is advisable
As soon as the ETT is placed, the cuff
should be inflated and its position
confirmed
19. Postintubation Management
CXR
use of long-acting NMBAs
(e.g., pancuronium, vecuronium)
toward optimal management using
opioid analgesics and sedative
agents to facilitate mechanical
ventilation
