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Intubation Steps

The placement of an ET tube is an important part of a resuscitation attempt, but it is a much lower priority than providing high-quality CPR and minimizing interruption during Cardiac arrest management.

ET intubation was once considered the gold standard for managing the airway during cardiac arrest. Due to Airway difficulties, supraglottic airway devices are considered an acceptable alternative to an ET tube for advanced airway management. There is no shame in using an iGel or LMA to minimize interruptions.

ET tube insertion steps:

  • Choose the appropriate size ET tube. Generally, an 8-mm internal diameter tube is used for adult males, and a 7-mm tube is used for adult females.

  • Choose the appropriate type and size laryngoscope blade.

  • Test the ET tube cuff integrity.

  • Lubricate ET Tube

  • Insert a stylet and ensure it does not stick out at the end.

  • Place head in a neutral position.

  • Open the mouth of the patient by using the "thumb and index finger" technique.

  • Insert the laryngoscope blade and visualize the glottic opening.

  • Have your suction ready.

  • Insert the ET tube and watch it pass through the vocal cords.

  • Inflate the ET tube cuff to achieve a proper seal.

  • Remove the laryngoscope blade from the mouth and ensure to switch it off.

  • Hold the tube with one hand and remove the stylet with the other hand.

  • Attach BVM to ET tube.

  • Assess proper placement by clinical assessment and device confirmation.

  • Auscultate for breath sounds and use quantitative waveform capnography or, if unavailable, an Exhaled CO2 detector or Esophageal Detector Device (EDD).

  • Squeeze the bag to give breaths (1 second each) while watching for chest rise.

  • Consider a bite-block

  • Secure the ET tube in place and note the level.

  • Provide ventilation at one breath every 6 seconds for adults and monitor the patient's condition and the position of the ET tube by using continuous waveform capnography.

  • Do an X-ray, if available, to optimize the ET tube position.

Disclaimer: This post is for educational purposes and is not intended as medical advice. While we strive for 100% accuracy, errors may occur, and medications or protocols may change over time.


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