Assessing and assuring an open airway and ventilation are two of the most important and sometimes challenging tasks that a paramedic will have. Without a way for air to enter and exit the lungs, human life is immediately compromised. It is for this reason that airway and ventilation skills are a vital part of paramedic education and training (Sanders, 2007). Endotracheal (ET) intubation is a procedure by which a tube is inserted through the mouth down into the trachea where the patient is often unconscious at the time of the procedure. The endotracheal tube serves as an open passage through the upper airway and is considered to be the “gold standard” in the pre-hospital care setting for complete airway control. This topic was submitted and approved on September 7, 2008 by Dr. Joan Glacken. Cognitive competencies
Before the students can successfully perform the endotracheal intubation competency, they will need to know the following: • Anatomy and physiology of respiration.
• Primary objective of airway maintenance.
• Perform the assessment of the airway and respiratory system. • Factors that affect respiratory rate and depth. • Methods for measuring oxygen and carbon dioxide in the blood. • Implications of partial and complete airway obstruction. • Bag-valve mask performance procedure
• Oropharyngeal placement procedure.
• Causes of respiratory distress.
• Risks of infection to paramedics associated with airway management. • Indications for endotracheal intubation.
• Contraindications for endotracheal intubation.
• Advantages for endotracheal intubation.
• Disadvantages for endotracheal intubation.
• Complications for endotracheal intubation.
• Equipment for endotracheal intubation.
• Method to select endotracheal tube size.
• Techniques for endotracheal intubation.
• Use of cricoid pressure during intubation.
• Methods to confirm correct placement of the endotracheal tube. Psychomotor competencies
The purpose of endotracheal intubation is to permit air to pass freely to and from the lungs in order to ventilate the lungs. It is often used when patients are critically ill and cannot maintain adequate respiratory function to meet their needs. Patients who typically need to have an endotracheal tube inserted are those in pulmonary or cardiopulmonary arrest, trauma patients in need of airway control and those in respiratory distress or failure due to overdose, fluid in the lungs, asthma, asphyxia, or allergic reaction (Limmer, 2007). As with any medical skill, there is required equipment that is necessary for successful completion. Before intubation, all equipment must be checked for defects. Personal protective equipment (PPE) utilizing body substance isolation (BSI) is required. A laryngoscope is necessary for visualization of the glottis during intubation. The standard laryngoscope includes a handle made of plastic or stainless steel and houses the batteries for the light source. The plastic or stainless steel blade is attached to the handle and when elevated to a right angle with the laryngoscope handle, the blade snaps into place and the bulb lights. Additional equipment includes an endotracheal tube with a stylet, 10 cc syringe for tube cuff inflation, magill forceps, tube tie, CO2 detection device, stethoscope, bag-valve mask, oropharyngeal/nasopharyngeal airway, lubricant and suction equipment. In preparation for patient intubation, the ET tube is lubricated and the stylet in inserted into the tube. The stylet must not extend past the end of the ET tube. Before the paramedic inserts the endotracheal tube, the patient will be hyperventilated with 100% oxygen by a second rescuer. This is accomplished by inserting an adjunct oropharyngeal or nasopharyngeal airway...