■ Air trapping or pneumothorax
■ From overaggressive ventilation or too large a bag (pediatrics)
■ If you suspect air trapping (eg, history of asthma or COPD), stop bagging
and squeeze the chest to help the patient exhale, then bag at a slower
rate.OROTRACHEALINTUBATIONINDICATIONS
■ Failure to maintain or protect the airway
■ Failure of oxygenation or ventilation
■ Anticipated deteriorationCONTRAINDICATIONS
■ There are no absolute contraindications.PROCEDURE
■ Position the patient.
■ Sniffing position of head
■ Open patient’s mouth.
■ Insert blade (using left hand) and sweep patient’s tongueto left.
■ Final position—in vallecula if curved blade
■ Underneath epiglottis if straight blade
■ Elevate epiglottis.
■ Lift the blade upward and forward at a 45° angle in the direction of the
handle.
■ Tracheal manipulation
■ BURP: Backward,Upward,RightwardPressure on thyroid and cricoid
cartilages
■ Bimanual laryngoscopy: Intubator moves trachea into view with right
hand.Assistant should then hold trachea in preferred position.
■ Brings the larynx further posterior and superior for better visualization
of cords
■ Improves visualization by one full grade, on average
■ Insert ET tube through cords. Inflate ET tube balloon.
■ Depth at teeth:
■ 23 cm for adult males
■ 21 cm for adult females
■ Children = (0.5 ×age in years) +12 cm or
3 ×the ET tube size.
■ Confirm tube placement.
■ ETCO 2 = best method.
■ Gold standard = fiberoptic visualization of tracheal rings through ET
tube.
■ Esophageal detector device
■ Syringelike aspiration device that is inserted into the end of ET
tube
■ No resistance to pulling plunger = tracheal intubation.
■ Resistance = esophageal intubation.
■ Other methods: Direct visualization, physical examination, pulse
oximetry, CXRRESUSCITATION
Tracheal manipula-
tion of the thyroid
and cricoid
cartilages—
BURP
Backward
Upward
Rightward
PressureBURP can improve
laryngoscopic visualization by
one full grade, on average.Confirmation of ETCO 2 is the
best method of confirming ET
tube placement.