Overview

Endotracheal Intubation is a procedure used to place a tube in the trachea to maintain airway patency and provide mechanical ventilation.

Endotracheal intubation is crucial for airway protection, mechanical ventilation, and management of respiratory failure in critically ill patients.

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Indications

✓
Respiratory Failure

Hypoxemia, hypercapnia

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Airway Protection

Decreased consciousness

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Cardiac Arrest

CPR airway management

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Shock

Hemodynamic instability

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Surgery

General anesthesia

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Complete airway obstruction

Relative Contraindications

✗ Cervical spine injury
✗ Maxillofacial trauma

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient assessment, equipment setup, pre-oxygenation, and understanding contraindications.

Step-by-Step Procedure

Step 1: Patient Assessment

Assess airway, breathing, circulation.

⚠️ Common Mistakes to Avoid:

  • Inadequate assessment
  • Missed contraindications

💡 Pro Tip:

Perform thorough airway assessment.

Step 2: Pre-oxygenation

Provide 100% oxygen for 3-5 minutes.

⚠️ Common Mistakes to Avoid:

  • Inadequate pre-oxygenation
  • Poor technique

💡 Pro Tip:

Use high-flow oxygen.

Step 3: Equipment Preparation

Prepare all equipment and check function.

⚠️ Common Mistakes to Avoid:

  • Missing equipment
  • Poor preparation

💡 Pro Tip:

Use checklist approach.

Step 4: Positioning

Position patient in sniffing position.

⚠️ Common Mistakes to Avoid:

  • Poor positioning
  • Wrong alignment

💡 Pro Tip:

Align ear, shoulder, hip.

Step 5: Laryngoscopy

Insert laryngoscope and visualize vocal cords.

⚠️ Common Mistakes to Avoid:

  • Wrong technique
  • Poor visualization

💡 Pro Tip:

Use proper blade technique.

Step 6: Tube Insertion

Insert tube and confirm placement.

⚠️ Common Mistakes to Avoid:

  • Wrong depth
  • Esophageal intubation

💡 Pro Tip:

Confirm with multiple methods.

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Post-procedure Care

Post-procedure care involves tube positioning confirmation, ventilator settings, and monitoring for complications.

Complications & Management

Complication Incidence Signs Management Prevention
Esophageal intubation 1-3% No breath sounds, gastric distension Remove tube, re-intubate Proper confirmation
Dental trauma 1-2% Broken teeth, bleeding Dental consultation Gentle technique
Hypoxemia 2-5% Decreased SpO2 Re-oxygenation, re-attempt Adequate pre-oxygenation
Vocal cord injury 1-2% Hoarseness, stridor Observation, steroids Gentle technique

Clinical Pearls

💡

Always pre-oxygenate adequately.

🎯

Use proper positioning and alignment.

⚡

Confirm placement with multiple methods.

🔍

Use capnography for confirmation.

📊

Monitor for complications.

🎨

Secure tube properly.

⚠️

Have backup plan ready.