Unfortunately, no one is safe from various injuries and diseases. In severe cases, it is necessary to immediately help a person in distress. Especially if he has life-threatening injuries. These include such emergency conditions as obstruction of the airways, cardiac arrest, shock, coma. Treatment of these pathologies should be carried out in the intensive care unit. Nevertheless, urgent measures need to be taken immediately after assessing the patient’s condition, that is, at the ambulance stage. In the ambulance car there is a set for tracheal intubation, a defibrillator, an Ambu bag. These medical devices are necessary only in severe cases when a person cannot breathe on his own.
What is an endotracheal tube for?
Naturally, tracheal intubation is an unpleasant procedure. But, despite the inconvenience, it is necessary for health reasons. To expand the airways and provide oxygen access to the lungs, an endotracheal tube is inserted. A doctor of any specialization should be able to intubate. Especially this skill is needed for resuscitators and anesthetists, emergency doctors. Thanks to the introduction of the endotracheal tube, ventilation again becomes normal, despite damage to the airways. In addition, using this mechanism, artificial oxygen can be supplied. There are many varieties of endotracheal tubes (about 20). They differ in size and the presence of an additional mechanism (cuff). All instruments for intubation are divided into 2 types: the oro- and nasotracheal tube. Their differences are in the ways of penetration to the respiratory organs. In the first case, the endotracheal tube is inserted through the mouth, in the second - through the nasal passages. In both cases, it is possible to develop complications due to organ damage. Therefore, before you choose the route of administration of the tube, you need to assess the risks. Nevertheless, intubation should be performed if necessary for the life of the body.
Indications for the introduction of the endotracheal tube
In severe conditions, ensuring airway is possible only by introducing an endotracheal tube into the oral or nasal cavity. In most cases, the patient does not feel pain during the procedure. Since people who need resuscitation are often unconscious. The following indications are given for tracheal intubation:
- The need for mechanical ventilation. Artificial lung ventilation is carried out not only at the ambulance stage, but also in the intensive care unit. This procedure is impossible without tracheal intubation.
- The need for general anesthesia. In this case, the introduction of an air tube is also mandatory. After all, during general anesthesia, all muscles are relaxed, including the respiratory muscles.
- The implementation of tracheal and bronchial lavage. This procedure is indicated for patients who collect mucus, the contents of the stomach in the respiratory tract.
- Improving gas exchange between the lungs and the environment.
It is believed that the endotracheal tube inserted through the mouth (orotracheally) is indicated for very severe conditions. Among them - a stop of respiratory and cardiac activity (clinical death) and coma of any origin. Nasotracheal administration has fewer complications and is considered more physiological. However, to prevent acute respiratory failure, doctors more often insert a tube through the mouth.
Tracheal Intubation Instruments
The resuscitator should always have a kit for tracheal intubation with him. It is stored in a special box with tools designed for pulmonary ventilation. The set for intubation, if necessary, is taken out of the intensive care unit. This is applicable in cases where patients are urgently required to conduct mechanical ventilation. Medical instruments included in the kit:
- Laryngoscope. This device is represented by two main components - a blade and a handle. It works thanks to the battery or batteries. They are inserted into the handle of the laryngoscope. Blades come in various sizes and shapes (curved and straight). This part is inserted into the oral cavity. At the end of the blade there is a light bulb that illuminates the airways. The choice of the size of the laryngoscope depends on the age of the patient, the state of the oral cavity.
- Different types of endotracheal tubes. The kit includes tools for intubation of both adults and children. They differ in size, presence or absence of the cuff, outer diameter, length, as well as in the number of gaps. Using these tubes, both oro- and nasotracheal intubation can be performed. Most often, women use size 7-8 ducts, for men - 8-10. In order to intubate adult patients, an endotracheal tube with a cuff is needed. To ensure patency of the children's respiratory tract - without it.
- A conductor to give the endotracheal tube the desired bend.
- Curved forceps.
- Anesthesia nebulizer.
Despite the fact that in practice not all tools from the set are used, their presence is necessary in full.
In what cases is the introduction of an endotracheal tube unacceptable?
Despite the fact that intubation is one of the necessary procedures, it has a number of contraindications. These include neck injuries, tumors in the oral and nasal cavities, and airway edema. In these cases, the introduction of the tube will not bring benefits, but only contributes to the development of severe complications (rupture of tissues, damage to the spinal cord). Therefore, before proceeding to intubation, it is necessary to examine the oral cavity and nose, to pay attention to the condition of the upper spine.
In addition, the introduction of the endotracheal tube may be difficult in some conditions that are not related to contraindications. Among them: a large tongue, a short neck or lower jaw, obesity, significantly protruding front teeth, a narrow oral cavity and abnormalities of the trachea. If the patient has such features, intubation should be carried out with caution. In these cases, preference is given to the introduction of a nasotracheal tube. It should be 1-2 sizes smaller.
Intubation Technique
Orotracheal intubation is performed as follows:
- The patient is laid on a hard surface, his head is thrown back a bit, and the lower jaw is advanced forward. As a result, the upper incisors are located on the same plane with the airways. If possible, then a roller is placed under the neck.
- If necessary, clean the oral cavity from vomit, clots, and dirt.
- A laryngoscope blade is inserted (on the right side). It is important not to touch the mucous membrane of the mouth and teeth.
- Then, an endotracheal tube is inserted. She passes by the oral cavity and larynx. At the level of the vocal cords, the tube must be carefully held between them into the tracheal cavity.
- The laryngoscope is removed.
- The cuff is inflated to fix the endotracheal tube.
Nasotracheal intubation is performed in much the same way. The differences are the size of the tube and its introduction into the nasal cavity. At the same time, a laryngoscope is not used.
How is the lungs ventilated for children?
There are cases when tracheal intubation is necessary for children. Most often it is necessary with deep prematurity of the fetus. Also, intubation is necessary during the neonatal period when identifying malformations of the respiratory and cardiovascular system. In both cases, mechanical ventilation is required . Indications for intubation in younger and older children are the same as for adults. Among them: acute respiratory failure, coma, general anesthesia.
What is the intubation depth scale?
The depth to which the endotracheal tube must be inserted depends on its size and the weight of the child. To do this, use a special scale. It is applicable to premature and newborn babies. With a child weighing up to 1 kg, an endotracheal tube of size 2.5 is used. The depth of its introduction is counted from the lips and is 6-7 cm. With a body weight of up to 2 kg, a tube size of 3 is used. The depth of administration should be no more than 8 cm. If the child weighs from 2 to 4 kg, then duct size No. 3 is used. ,5. The depth is equal to from 9 to 10 cm. For newborns and infants whose body weight is more than 4 kg, use a tube 4 sizes. Depth of introduction - up to 11 cm.
What can be the complications after tracheal intubation?
It is worth remembering that the introduction of an endotracheal tube is dangerous with such a complication as damage to the mucous membrane of the internal organs. Therefore, this manipulation should be carried out by an experienced specialist. In the intensive care unit, before starting intubation, anesthesia is performed. The most common complications include: damage to the teeth, pharyngeal mucosa, tube getting into the esophagus. To avoid this, it is necessary to carefully monitor the patient's condition.
The introduction of the endotracheal tube: expert opinion
The technique of intubation is owned by every doctor. Nevertheless, resuscitators and anesthetists do this manipulation best. In their opinion, tracheal intubation without special preparation and in the absence of sterility conditions is not possible. After all, the complications of this procedure can be irreversible. Nevertheless, a doctor of any specialty is obliged to provide first aid for health reasons.