RT should assist with the following at all intubations
Indications
Airway compromise
Respiratory Failure
RT 1 will stand at the head of the bed when bagging before the intubation process begins and to the right of the Airway physician during the actual intubation attempts
Each intubation attempt is limited to 15-30 seconds
Equipment Needed
Resuscitation bag or mask
Oxygen source
Suction source
Suction equipment - catheter / tonsil tip
Laryngoscope with an appropriate sized blade(s)
Endotracheal tubes of appropriate sizes
Stylet
Syringe 10cc
CO2 detector
Adhesive tape
Oral/Nasal airway
Lubrication gel
Liquid skin barrier
Liquid Adhesive
Monitor / Pulse ox
LMA
Determine Tube Size for a Cuffed and Uncuted ETT
ETT uncuffed size = 16 + age / 4
ETT cuffed = 16 + age /4 and drop down to the next tube size (5 to 4.5)
Determine what the Approximate Depth of the ETT should be by multiplying 3 X ETT size
Roles for the 2 RTS involved
RT 1
Assists the physician managing the airway with administration of oxygen or provision of assisted respiratory support if patient’s respirations are absent or inadequate
Maintains manual immobilization of the cervical spine during intubation and all procedures, or delegates this to another trauma team member as needed
Secures and reassesses tube placement throughout resuscitation and stabilization
Places ETCO2 adaptor and connect to the monitor for an intubated patient
Monitors ETCO2 and pulse oximetry and patient’s response to interventions
Initiates mechanical ventilation during evaluation and stabilization of the patient, if indicated
RT 2
Assists ED Respiratory Therapist & Airway Physician with management of airway
Prepares airway and intubation equipment
Locates and prepares non-invasive airway options or ventilator as needed
Communicates with recorder RN to verify ETT placement after X-ray obtained
Runs blood gases as ordered, reports results to recorder RN
Rotates in for CPR as needed
Steps of Intubation:
Identify the size range of equipment to be used for the individual patient
Check the equipment for proper function and assemble
Insure that both oxygen and suction are available
Establish a patent airway by manual positioning of the patient. Use an oral/nasal airway if indicated
Ventilate and support the oxygenation status of the patient with a bag/mask device
Suction the patient's oropharyngeal airway as indicated
Placement of an oral/nasal gastric tube should be done if gastric distension from insufflation is observed or if mask ventilation is prolonged – greater than 2 minutes
Open the patient's mouth and insert the laryngoscope blade, avoiding any trauma
Position the laryngoscope blade correctly and apply anterior traction to the patient's tongue and jaw
Insert the endotracheal tube tip through the patient's vocal cords
Inflate the endotracheal tube cuff if indicated
Confirm the appropriate endotracheal tube position after intubation
Note the cm marking at the patient's gum/teeth and secure the endotracheal tube appropriately
Obtain and inspect the patient's post-intubation chest X-ray
Between each intubation attempt you should:
Establish a patent airway manually
Ventilate and support the oxygenation status of the patient with a bag/mask device
Suction the patient's airway as indicated
To Determine Successful tube Placement
Listen for the presence of bilateral breath sounds
Listen for the absence of ventilation sounds over the left upper quadrant of the abdomen
Presence of CO2 in the exhaled gas
Clinical monitoring parameters indicate that the endotracheal tube is properly positioned
Confirm ETT Placement is good on XRAY
Make sure the tube is
Above the carina
Below the clavicles
Somewhere in between t-2 and t-3
Documentation
Document under Intubation / Extubation in the Airway Band (Compass)
Should include the number of attempts, airway size and depth, securing method, and the verification of tracheal intubation (CO2, X-ray, condensation in the tube, etc.)
Cleaning
Laryngoscope blades should be sent to sterile processing
Laryngoscope handles should be wiped down with a Sani wipes