Scribd
Upload
499 views

Airway Management

1. Rapid sequence intubation is a technique used to induce loss of consciousness, paralysis of the vocal cords to facilitate endotracheal intubation and prevent aspiration. 2. The "7 Ps of intubation" outlines the preparation, preoxygenation, pre-medication, paralysis, positioning, placement and confirmation, and post-intubation care necessary for safe and effective endotracheal intubation. 3. Factors like metabolism, respiration, circulation, medications, and the patient's underlying condition can affect end-tidal carbon dioxide (EtCO2) levels as seen on waveform capnography, which is used to confirm proper endotracheal tube placement.

Uploaded by

paveethrah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
499 views

Airway Management

1. Rapid sequence intubation is a technique used to induce loss of consciousness, paralysis of the vocal cords to facilitate endotracheal intubation and prevent aspiration. 2. The "7 Ps of intubation" outlines the preparation, preoxygenation, pre-medication, paralysis, positioning, placement and confirmation, and post-intubation care necessary for safe and effective endotracheal intubation. 3. Factors like metabolism, respiration, circulation, medications, and the patient's underlying condition can affect end-tidal carbon dioxide (EtCO2) levels as seen on waveform capnography, which is used to confirm proper endotracheal tube placement.

Uploaded by

paveethrah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 4

Airway Management - Intubation

1. Rapid sequence intubation:- a technique of intubation using induction & paralytic agents
to induce LOC & paralysis of vocal cord and to facilitate
tracheal intubation & prevent aspiration
2. Indication:-
①failure of oxygenation
②failure of ventilation
③To maintain airway patency
- Intraluminal:- foreign body
- Luminal:- angioedema, anaphylaxis, haematoma
- Extraluminal:- haematoma, trauma
④To protect airway
⑤clinical deterioration that leads to ① & ③

7 P’s of intubation
Male ETT size = 7-8
a) Preparation – MEALS Female ETT size = 6-7
- Medication, mask Prepare ETT + 0.5
- Endotracheal tube Secure ETT at 3times the size of
- Adjust airway ETT (eg size 7 – secure at 21cm)
- Laryngoscope
- Stylet, suction, syringe, stethoscope, staff, self

b) Preoxygenation – high flow mask/ bag valve mask with 100% O2


 For nitrogen washout for around 3-5 mins depending on patient’s body weight
 So when patient becomes apneic, there is no oxygen entering lung & thus 100% O2 will
provide as store in lungs
*Short duration >> obese, pregnant
*Bag only when patient desaturate/ apneic
*Do not bag if patient can self-ventilate

c) Pre-medication:- LOAD
- Lignocaine [obtund cough/ gag reflex, reduce pain, obtund sympathetic reflexes (BP,
HR, ICP ↓)]
- Opiod (fentanyl) 1mcg/kg
- Atropine (when BP ↓)  used in paeds
- Defasciculating agent

Prepared by Leow Zhe Eu Group 4 Year 5 2014/2015


d) Paralytic agent
Induction agent (PROF KETAM) Muscle Relaxant
 Propofol 1mg/kg (cardiorespitatory ↓)  Succinylcholine 0.6-1.2mg/kg –dangerous
 Ketamine 1mg/kg (able to ↑ BP) with hyper-K,but can be used in acute
 Etomidate 0.3mg/kg (maintain BP) burn
 Thiopental 1mg/kg –(cardiorespiratory ↓)  Rocuronium 1mg/kg
 Midazolam 0.1mg/kg – (cardiorespiratory  Vecuronium
↓) *if unsure, use rocuronium
*C/I for succinylcholine
 h/o of maligant hyperthermia
 burn/crush injury >5/7
 stroke/ spinal cord injury >5/7
 MS/ ALS/ inherited myopathy
 known hyperkalemia (absolute)
 renal failure (relative)
 suspected hyperkalemia (relative)

e) Positioning:- Sniffing position


- Flexion of neck & extension of hand
- Put pillow/ donut below head about 10cm
- External auditory meatus must be of same plane with sternal angle

f) Placement & confirmation


① Direct visualization
② Symmetrical chest rise Post-intubation assessment (Dr. Arif)
Subjective – Vapour at ET tube
③ Presence of vapour on ETT - Symmetrical chest rise
④ 5 point auscultation (most important at epigastrium) - 5 point auscultation
*remove if hand gurgling/bowel sound; Objective – ETCO2
*other site bilateral infra-clavicular & upper axillary - SpO2 in ABG
⑤General well being of patient (cyanosis → pink) - CXR
⑥ ETCO2 waveform capnography (N : 35-45 mmHg)

g) Post-intubation care
① Secure ETT
② Connect to ventilator
③ Prop up 30-45°
④ Airway:- Ryle’s tube (gastric decompression)
⑤ Breathing:- Auscultate for complication (eg. Pneumothorax)

Prepared by Leow Zhe Eu Group 4 Year 5 2014/2015


⑥ Circulation:- Blood for investigation
- Fluid
- Analgesia
⑦ Disability – Sedation
⑧ Exposure/ Environment:- hypothermia – induced in ACS, do not induce in trauma
- hyperthermia
⑨ Gastric protection:- PPI (eg. Pantoprazole)
⑩ Continuous bladder drainage – Monitor I/O charting
⑪ Disposition:- ICU/ HDU
______________________________________________________________________________

Waveform Capnography

Factors affecting EtCO2

Hypercapnia (↑ EtCO2) Hypocapnia (↓ EtCO2)


Metabolism Metabolism
- pain - hypothermia
- hyperthermia - metabolic acidosis
- shivering
Respiratory Respiratory
- insufficiency - hyperventilation
- depression - bronchospasm

Prepared by Leow Zhe Eu Group 4 Year 5 2014/2015


- COPD - mucus plug
- Analgesia/ sedation
Circulatory Circulatory
- ↑ CO2 - Hypotension
- Tourniquet release - sudden hypovolemia
- cardiac arrest
- Pulmonary emboli
- shock
Medications
- Bicarbonate administration
- Effective drug therapy for bronchospasm

CREDITS
I would like to express our gratitude and appreciation to Dr Zikri for his guidance and
teachings throughout resuscitation week for Year 5 2014/2015.
Thanks to all who had assisted directly and indirectly.

Prepared by Leow Zhe Eu Group 4 Year 5 2014/2015

You might also like