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INTUBATION VS THEIR INDICATION, PROCEDURE, COMPLICATIONS

 1.WHAT IS ENDOTRACHEAL INTUBATION ? 

 Endotracheal intubation is the placement of a special tube in trachea

2.WHAT ARE THE INDICATION OF INTUBATION ? 

 * To secure airway

* to supply oxygen

* general Anesthesia

 *Cardio pulmonary resucitation

* ventilatory therapy in ICU 

3. EQUIPMENTS REQUIRED FOR INTUBATION 

*Different sizes of cuffed and plain

ET TUBE 

 0-1 yrs-  2.5 to 3.5 mm ( plain ) 

1-3 yrs- 4to 5 mm 

 4-6 yrs - 5 to 6 mm 

 6-10 yrs - 6 to 7 mm( cuffed ) 

adult female - 7 to 8 mm 

 adult male - 8 to 9 mm 

 *laryngoscope

* magill's forceps

* Stethoscope 

* syringe 

*source for ventilation *suction  

4.TECHNIQUE OF INTUBATION 

*Raise the head by 5cm with a block or ring pillow 

* Extension at atlanto-occipital joint

* Flexion at neck 

* hold the laryngoscpoe with LEFT hand irrespective of dominant hand

* open the mouth with right hand index finger with support of thumb

 *introduce Laryngoscpoe from right angle of mouth

*shift the tongue to left go in

* press over tongue

* see Epigllotis and lift ît 

*watch for voccal cords 

* take the tube in right hand 

*introduce under vision 

*confirm placement by auscultation 

*if tube is cuffed inflate the cuff with syringe 

* connect the source to tube

5.CONFIRMATION OF INTUBATION 

*  by auscultation 

* by chest expansion 

*by bag movement 

* end tidal CO2

AFTER INTUBATION 

 *fix the tube with adhesive 

*conection to ventilate with ambu's Bag, anesthesia machine or ventilator 

6.CONFIRMATION OF INTUBATION 

 *Tachycardia 

*rise in blood pressure 

*Increase in secretions 

* Laryngospasm 

* bronchospasm

*tube in oesophagous

* endobrocheal intubation 

*trauma to lips tooth

 *Bleeding

* Leak 

*Trachities 

*Cough

* sore throat

* barotrauma to Lungs 

7.EFFECTS OF INTUBATION 

 *increase in supply of O2

* to give general anesthesia

* improove exhalation of C02 

8.EXTUBATION 

It is advisable if the cause is treated 

* throat suction  *Laryngoscopy 

* Reflexes

* Spo2

* adequate respiration *level of consciousness 

* extubate 

FAILED OR DIFFICULT INTUBATION 

 *if mouth opening restricted

* anterior vocal cords *burn contracture 

For these condition one may require other options like

 fibro optic intubatioñ

* awake intubation 

* retrogate intubation *supra epiglotic device like Laryngeal mask airway (LMA)



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