endotracheal tube

Endotracheal intubation

Endo - Prefixes indicating within, inner, absorbing, or containing

Tracheal - Anatomical area of the human body, the trachea. also called the windpipe.

You have a patient with a GCS of 7, their respirations are agonal and oxygen saturation is 84%. First rule for anyone in the medical field is to get oxygen back into the is person’s body and fast. One of the common ways in the field and the Emergency room are to place what they call an Endotracheal tube.

The cartilage in your neck, more predominant on men as the “Adams apple,” this is called the thyroid cartilage. It houses your vocal cords and is the immediate opening of the airway. When you look down into a patient’s throat, using a MAC or MIL blade, you will be looking for the epiglottis (the little flap that covers the airway when you swallow food. Then you’ll look for the vocal cords.

The ET tube will have to slide past this to be able to work properly. Once you are confident in your placement and have followed your steps to secure it, you will test it. Some people forget that to auscultate the stomach, listening for gurgling sounds is the first thing you do when pushing air. This means you put it in the esophagus and that is BAD! If that happens, You can pull back tube and try again.

Auscultation of lung sounds bilaterally will be important, to make sure you haven’t slipped the tube past the carina and into one of the bronchioles. Secure the airway and maintain. Remember to always document.

This is just a brief overview. I have place advanced airway techniques video under as a better reference. Remember though, airway is one of the top priorities in the medical field. Without air, it only takes about 4 minutes to cause severe brain damage.

Written by: Meddaily

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Tracheal intubation , usually simply referred to as intubation , is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain
drugs.
*To begin the procedure,open the patient’s mouth by separating the lips and pulling on the upper jaw with the index finger.
*Holding a laryngoscope in the left hand, insert the curved blade into the mouth of the patient with the blade directed to the right tonsil.
*Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view.
*The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis.
*Next, with the handle of the laryngoscope pointing away from you at 45°, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view.
*With the right hand, insert the endotracheal tube, made of flexible plastic, into the mouth directly between the cords to the point that the cuff rests just below the cords.
*The markings on the tube at the incisors will show between 21 and 24cm in the average sized adult when the tube is in position. Finally, remove the laryngoscope. The cuff is inflated to provide a minimal leak when the bag is squeezed.
*Using a stethoscope , the anesthesiologist listens for breathing sounds to ensure correct placement of the tube.

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Rapid Primary Survey

When it comes to primary surveys in trauma situations, my skills will never be to the same standard as the emergentologist. However, in those times when I have had to do it, this checklist has worked for me. I am missing a few points that probably could be included for comprehensiveness but in general it covers all the necessary points.

AIRWAY

  • Secure.
  • Suspect cervical injury? C-spine collar.
  • Talking. Breathing.
  • Head tilt/jaw thrust > Airway > Endotracheal tube.

BREATHING

  • Look: Tracheal midline. Mental status. Color. Respiratory rate. Work of breathing.
  • Listen: Breath sounds. Obstruction? Symmetry?
  • Feel: Trachea. Chest crepitus. Deformity.

CIRCULATION

  • Level of consciousness. Heart sounds. Blood pressure. Heart rate/respiratory rate. Cool extremities. Urine output.
  • Abdominal pain.
  • ABC. Maintain pressure. 2 large bore IV. Transfuse if severe.

DISABILITY/DEFORMITY

  • GCS. Neurovascular status. Squeeze pelvis. Check long bones. Look for the blood. 

FAST (Focused Assessment Sonography in Trauma)

Radiograph of an older man who was admitted to the intensive care unit postoperatively, note the right sided pneumothorax induced by the incorrectly positioned small-bowel feeding tube in the right sided bronchial tree, marked depression of the right hemidiaphragm is noted, and mediastinal shift is to the left side, suggestive of tension pneumothorax, the endotracheal tube is in a good position