Endotracheal Intubation

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Indications for Intubation

If a patient extubates themself:

Call for help

Use BVM to maintain open airway

Prepare for emergency reintubation. MD or RT will perform and each attempt should not be longer than 10 seconds.

ETT Placement

Position the pt supine, elevate head unless suspected neck trauma

Preoxygenate using 100% O2 with BVM

Anticipate med admin

After ETT is inserted, assess for bilateral breath sounds while ventilating with BVM through ETT using 100% O2. Conduct secondary confirmation with colorimetry.

Continue to monitor SpO2 and cardiac rhythm. Check for symmetrical chest expansion.

Secure ETT with holder and mark depth of ET placement

Obtain chest x ray to confirm placement

Post Intubation Priorities

Reassure pt

Monitor VS, cardiac rhythm, pain, and agitation

Verify ventilator settings

Post 30 min, analyze ABGs (high PO2 and low PaCO2 anticipated because of high oxygenation following reintubation)

Maintain adequate cuff pressure

Preventing Complications

Strategies to prevent VAEs include:

oral care with CH

PPI to prevent stress ulcers

Sedation interruption

HOB to 30 degrees

VTE prophylaxis