Unfortunately, no one is immune from various injuries and diseases. In severe cases, it is necessary to immediately help the person in trouble. Especially if he has injuries that are life-threatening. These include such emergencies as airway obstruction, cardiac arrest, shock, coma. Treatment of these pathologies should be carried out in the intensive care unit. Nevertheless, urgent measures must 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 needed only in severe cases, when a person cannot breathe on his own.
What is an endotracheal tube for?
It is natural that tracheal intubation is an unpleasant procedure. But, despite the inconvenience, it is necessary for he alth reasons. An endotracheal tube is inserted to widen the airways and provide oxygen to the lungs. Be able toshould be intubated by a doctor of any speci alty. This skill is especially necessary for resuscitators and anesthesiologists, emergency doctors. Thanks to the insertion of an endotracheal tube, ventilation of the lungs becomes normal again, despite damage to the airways. In addition, using this mechanism, it is possible to carry out an artificial supply of oxygen. 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: 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. With both options, complications may develop due to organ damage. Therefore, before choosing the route of insertion of the tube, you need to evaluate the risks. However, intubation should be performed if necessary for the life of the organism.
Indications for endotracheal tube insertion
In severe conditions, airway patency is possible only by inserting an endotracheal tube into the oral or nasal cavity. In most cases, the patient does not feel pain during the procedure. Since people who require resuscitation are often unconscious. There are the following indications for tracheal intubation:
- The need for mechanical ventilation. Artificial ventilation of the lungs is carried out not only at the stage of ambulance, but also in the departmentresuscitation. This procedure is impossible without tracheal intubation.
- The need for general anesthesia. In this case, the introduction of an air tube is also mandatory. Indeed, during general anesthesia, all muscles relax, including the respiratory muscles.
- Implementation of tracheal and bronchial lavage. This procedure is indicated for patients who collect mucus, stomach contents in the respiratory tract.
- Improve gas exchange between the lungs and the environment.
It is believed that an endotracheal tube inserted through the mouth (orotracheally) is indicated for very serious conditions. Among them are respiratory and cardiac arrest (clinical death) and coma of any origin. Nasotracheal administration has fewer complications and is considered more physiological. However, to prevent acute respiratory failure, doctors are more likely to insert a tube through the mouth.
Instruments for tracheal intubation
A resuscitator should always have a tracheal intubation kit with him. It is stored in a special box with instruments 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 indicated for mechanical ventilation. Medical instruments included in the set:
- Laryngoscope. This device is represented by two main components - the blade and the handle. It works thanks to the accumulator or batteries. They are inserted into the handle of the laryngoscope. Blades aredifferent 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 laryngoscope size depends on the age of the patient, the condition of the oral cavity.
- Different types of endotracheal tubes. The set includes instruments for intubation of both adults and children. They differ in size, the presence or absence of a cuff, outer diameter, length, and the number of gaps. These tubes can be used for both oro- and nasotracheal intubation. Most often, women use air ducts of size 7-8, for men - 8-10. For the purpose of intubation of adult patients, an endotracheal tube with a cuff is required. To ensure the patency of children's respiratory tract - without it.
- Guide to give the endotracheal tube the desired bend.
- Curved tongs.
- Anesthesia drug dispenser.
Despite the fact that not all tools from the set are used in practice, their presence is necessary in full.
When should an endotracheal tube be inserted?
Despite the fact that intubation is a necessary procedure, it has a number of contraindications. These include: neck injuries, tumors in the oral and nasal cavity, swelling of the airways. In these cases, the introduction of the tube will not be beneficial, but only contributes to the development of severe complications (tissue rupture, spinal cord injury). Therefore, before proceeding with intubation, it is necessary to examine the oral cavityand nose, pay attention to the condition of the upper spine.
In addition, the insertion of an endotracheal tube may be difficult in some conditions that are not contraindications. Among them: a large tongue, a short neck or lower jaw, obesity, significantly protruding front teeth, a narrow mouth and tracheal anomalies. If the patient has these 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, the head is thrown back a little, and the lower jaw is pushed forward. As a result, the upper incisors are on the same plane with the airways. If possible, a roller is placed under the neck.
- If necessary, clean the oral cavity from vomit, clots, dirt.
- The 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. It passes by the oral cavity and larynx. At the level of the vocal cords, the tube must be carefully passed between them into the tracheal cavity.
- The laryngoscope is removed.
- Inflate the cuff to secure the endotracheal tube.
Nasotracheal intubation is done in much the same way. The differences are the size of the tube and its introduction into the nasal cavity. Whereinlaryngoscope not used.
How are babies ventilated?
There are cases when tracheal intubation has to be performed on children. Most often this is necessary for deep prematurity of the fetus. Also, intubation may be necessary in the neonatal period when malformations of the respiratory and cardiovascular systems are detected. 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 insertion is measured 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 insertion depth should be no more than 8 cm. If the child weighs from 2 to 4 kg, then the size of the air duct No. 3, 5 is used. The depth is from 9 to 10 cm. For newborns and infants whose body weight is more than 4 kg, use a size 4 tube. Insertion depth - up to 11 cm.
What are the possible 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 mucosamembranes of 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 entry into the esophagus. To avoid this, it is necessary to carefully monitor the patient's condition.
Introduction of the endotracheal tube: expert opinion
Each doctor owns the technique of intubation. Nevertheless, this manipulation is best done by resuscitators and anesthesiologists. In their opinion, it is impossible to carry out tracheal intubation without special training and in the absence of sterile conditions. After all, the complications of this procedure can be irreversible. Nevertheless, a doctor of any speci alty is obliged to provide first aid for he alth reasons.
