Intubation Obstacle Course February 2011 CE Condell Medical Center EMS System Site code 107200E - 1211

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2. Goals. Upon effective finish of this module, the EMS supplier will have the capacity to: 1. Depict the aviation route life systems in the grown-up, kid and newborn child populations.2. Clarify the pathophysiology of aviation route compromise.3. Audit the utilization of oxygen treatment in instances of aviation route administration in extreme situations.4. Depict the estimation, situation, and appraisal of oropharyngeal and nasopharyngeal airw

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Slide 1

Intubation Obstacle Course February 2011 CE Condell Medical Center EMS System Site code #107200E - 1211 Prepared by: FF/PM Erich Castillo; Greater Round Lake Fire Department Reviewed/overhauled by: Sharon Hopkins, RN, BSN, EMT-P

Slide 2

Objectives Upon fruitful consummation of this module, the EMS supplier will have the capacity to: 1. Portray the aviation route life systems in the grown-up, kid and baby populaces. 2. Clarify the pathophysiology of aviation route trade off. 3. Audit the utilization of oxygen treatment in instances of aviation route administration in extreme circumstances. 4. Portray the estimation, situation, and appraisal of oropharyngeal and nasopharyngeal aviation routes. 5. Clarify the benefit of performing propelled aviation route strategies.

Slide 3

Objectives cont'd 6. List signs, contraindications, and confusions of ET intubation. 7. List gear required for oral intubation. 8. Clarify the method of reasoning for having a suction unit instantly accessible amid intubation endeavors. 9. Express as far as possible for suctioning in the grown-up, kid and newborn child populaces. 10. Portray the strategies for picking the proper estimated endotracheal tube in a grown-up, youngster and baby populaces. 11. Clarify the basis for utilizing the stylet amid intubation. 12. Depict the best possible utilization of a stylet in orotracheal intubation.

Slide 4

Objectives cont'd 13. Portray the points of interest utilized with the Macintosh and Miller edges for oral intubation. 14. Portray the expertise of orotracheal intubation in the grown-up, tyke and newborn child populaces. 15. Portray the means in affirming endotracheal tube arrangement in the grown-up, kid and newborn child quiet. 16. Depict the utilization of the ETCO 2 screen. 17. Depict the utilization of capnography to screen understanding condition. 18. Express the outcome of and the need to perceive inadvertent esophageal intubation. 19. Clarify the method of reasoning for securing the endotracheal tube.

Slide 5

Objectives cont'd 20. Portray the system of securing the endotracheal tube in the grown-up, newborn child and tyke populaces. 21. Audit documentation segments of the patient who has been intubated. 22. Exhibit the ability of measuring and setting the oropharyngeal and nasopharyngeal aviation routes in the grown-up patient. 23. Show the ability of orotracheal intubation in the grown-up patient. 24. Exhibit affirmation of endotracheal tube position in the grown-up patient.

Slide 6

Objectives cont'd 25. Show the aptitude of securing the endotracheal tube in the grown-up patient. 26. Show the aptitude of intubation on the grown-up patient with various difficulties and numerous deterrents restricting the patient (in-line, eye to eye, in bound space, computerized intubation, with an outside body).

Slide 7

Upper and Lower Airways Upper aviation route structures Nose Mouth/Pharynx Lower aviation route structures Alveoli

Slide 8

Pediatric Airway Funnel Shaped Peds Airway Adult Airway

Slide 9

Airway Compromise Blockage Improper situating Foreign bodies Improperly set ETT Swelling Trauma Blunt, pounding damage Burns Improper utilization of aviation route extras Disease Asthma Croup Epiglottitis

Slide 10

Oxygen Therapy If the patient is in critical need and requires oxygen, the greatest sum is to be conveyed Airway bargain Shock Impending capture Arrest Use best instrument for the circumstance Non-rebreather BVM

Slide 11

Future Trend - Oxygen Therapy New research = future practice Hyperventilation pitfalls  intrathoracic weight which  CO Compromises systemic blood stream Hypocapnia (low CO 2 ) may intensify worldwide cerebrum ischemia because of over the top cerebral vasoconstriction 100% O 2 declines here and now utilitarian result contrasted with titrated O 2 use to SaO 2 of 94-96%

Slide 12

New SOP's Coming Watch for amendments in oxygen organization rules coming to you in the overhauled SOP 2011 More to take after!

Slide 13

"Securing" the Airway Definition of a secured aviation route Whatever it takes to have and keep up an open aviation route Whatever it takes to ventilate the patient Whatever it takes to keep up sufficient oxygenation levels New pattern: oxyhemoglobin immersion > 94% Includes utilization of situating and aviation route aide devices – essential and progressed

Slide 14

Open versus Blocked Airway Vocal ropes Larynx Tongue Trachea Esophagus Positioning of aviation route imperative for keeping aviation route open

Slide 15

Airway Maneuvers Head-tilt/button lift Maneuver used to open the aviation route to calm deterrent by the tongue Reliable, tried and true Often under-used ability Recommended for every oblivious patient If suspected cervical spine harm, perform changed jaw push with in-line adjustment of the cervical spine

Slide 16

Airway Adjuncts Mechanical aviation routes Helps lift base of tongue forward, far from back oropharynx Does not supplant great head situating Oropharyngeal aviation routes NOT for patients with a muffle reflex!!! Nasopharyngeal aviation routes Tolerated by patients with and without muffle reflex

Slide 17

Oropharyngeal Airway Noninvasive; takes after bend of sense of taste Indicated in patients with NO stifler reflex Check for nearness of flicker reflex Facilitates suctioning Can be utilized as a chomp square to ensure an endotracheal tube Does NOT shield from desire

Slide 18

Oropharyngeal Airway 1 Measure 2 Place 3 Assess Check that the tongue was not incidentally pushed back hindering the aviation route

Slide 19

Nasopharyngeal Airway Uncuffed delicate tube; takes after bend of nasopharynx to simply beneath base of tongue Indicated for delicate tissue upper aviation route obstacle Tolerated by patients with and without muffle reflex Not prescribed for facial or head injury Can bring about more injury amid situation

Slide 20

Nasopharyngeal Airway 1 Measure 2 Place 3 Assess

Slide 21

Nasopharyngeal Airway Inserted angle side toward the septum LUBRICATE; LUBRICATE; LUBRICATE Right nares slides in Left nares, begins topsy turvy (slant to the septum) and turned into position TIP: pull up on tip of nose to rectify bend that may piece simplicity of inclusion Did we say LUBRICATE?! Right nares Left nares

Slide 22

Advanced Airway Techniques Using an obtrusive gadget with extra hardware to secure the aviation route

Slide 23

Indications for Intubation Inadequate oxygenation Inadequate ventilation Need to control and evacuate aspiratory emissions Need to give aviation route assurance in a lethargic patient or a patient with a discouraged stifler reflex

Slide 24

Intubation Contraindications Awake patient Airway can be overseen less intrusively Severe aviation route injury or obstacle that does not allow safe section of an endotracheal tube Cervical spine harm, in which the requirement for finish immobilization of the cervical spine makes endotracheal intubation troublesome (relative contraindication)

Slide 25

Potential Complications During Intubation Inability to view vocal ropes Breaking teeth/dislodging bridgework Damage to gums Faulty sleeve Unrecognized esophageal intubation Unrecognized right fundamental stem intubation Laryngospasm Failure to finish intubation

Slide 26

BVM Laryngoscope with bended as well as straight cutting edge ET tube (size of little finger for peds) Extra ET tube – one size up and one size down Stylet Suction unit Oral aviation routes 10 ml syringe Lubricant Gloves Eye Protection Stethoscope Method to secure ET tube set up Equipment Required

Slide 27

Opening the Airway & Creating A Seal Proper situating of patient basic to place aviation route in most ideal plane Proper seal basic when utilizing the BVM Use "EC" procedure

Slide 28

BVM Assisted Ventilations Hand-held gadget to give positive ventilations to patients Absent breaths Ineffective ventilations Must have legitimate seal to counteract air spillage Rate adequate for circumstance Risk of over expansion of lungs, gastric widening, regurgitating To bolster ventilations in nearness of unconstrained pulse once every 5 - 6 seconds in grown-ups; once every 3 - 5 seconds in peds up to 8 years old To ventilate by means of ET tube – once every 6 - 8 seconds in all peds and grown-ups

Slide 29

Suctioning Removes discharges and oxygen!!! May animate choking and regurgitating Most EMS patients not NPO! Point of confinement to 10 seconds for grown-ups Limit to 5 seconds in the pediatric populace Watch for hypoxia instigated bradycardia Suction on evacuation of catheter just

Slide 30

Typical Sizing ETT Generic rules Use length based tape (ie: Broselow ) for pediatric measuring rules

Slide 31

Stylet Used to offer frame to the ETT Use is by individual inclination NEVER to reach out past distal tip of ETT Recess tip of stylet roughly 2cm ( 3/4 ″) from distal opening Bend over abundance stylet to avert unintentional injury to tracheal divider Place tip in "hockey stick" position Could likewise change ETT into a bend

Slide 32

Straight Blade Miller Blade lifts epiglottis Vocal lines are uncovered Direct representation permitted 30 second time cutoff to intubate!!!

Slide 33

Curved Blade - Macintosh Blade put in vallecular space Use left lower arm to lift life systems out of approach to view vocal strings Lifting movement moves epiglottis off the beaten path 30 second time cutoff to intubate!!!

Slide 34

Choosing the Correct Pediatric Blade Size Measure utilizing space from tip of sharp edge to score Measure from tyke's upper incisor to edge of jaw inside +/ - 1/2 ″

Slide 35

Difficult Airways – What Are You Going To Do? Situating Peds Anatomy Swelling Obstructions

Slide 36

Do you have satisfactory cushioning? Assess the patient in the level position Draw a nonexistent line from ear to shoulders Patient will then be "in line" Add to or subtract cushioning when cervical spine can be moved

Slide 37

Foreign Body Magill forceps Useful to haul out outside bodies from the aviation route Can be utilized to direct ET

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