Assisting Intubation

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h14This is a short article looking at assisting with intubation. Ensure you have a good knowledge of what all devices are called so to avoid confusion if the anaesthetist or paramedic asks for a certain device. Lay out all devices required in a sterile environment so they are ready at hand when needed. Ensure you have a range of sizes for the different tools available, e.g. size 7, 8, 9 ET tubes, size 3, 4 laryngoscope blade. Place the items to the side of the operator if you are required to do chest compressions, or be at hand ready to pass over items when required. Ensure there is a Bougie or Introducer at hand in case of a difficult intubation. If these items are used be prepared to assist in feeding the ET over them so that they can be placed in the airway.

Consider whether the patient will be a difficult intubation, do they have excessive features like a large tongue or neck. Is there evidence of airway obstruction where suction or forceps may be required to remove the debris. If there is no obstruction and the health care professional is finding it difficult to intubate, consider assisting in positioning of the
Airway bag

patient and conducting airway/intubation manoeuvres (if you are not actively conducting CPR).

Consider whether there is an object such as a pillow in the vicinity where you could place it under the patients’ neck to provide some better sight alignment of the airway (ensure the patient has no c-spine compromise before doing this). If able to do so, consider a jaw thrust manoeuvre or lifting of the chin to aid in opening up the airway and providing better sight. Consider the BURP (Backwards Upwards Right Pressure) manoeuvre, place some fingers on the trachea and apply some pressure in the ‘BURP’ order. The health care professional may direct you where to apply further pressure with what they can visualise.

You can use the Sellick manoeuvre where there is risk of the patient vomiting whilst being intubated. Locate the cricoid cartilage and apply pressure towards the oesophagus. The idea is to collapse the oesophagus so no vomit can pass through the passageway. Use judgement when applying pressure and be cautious if querying a c-spine injury.

Once the intubation process is complete have a 20ml syringe filled with air ready for the health care professional to inflate the cuff. You may need to assist in holding the stethoscope head when auscultating the patient for tube placement confirmation. Once the tube is confirmed and tied in place, attach a catheter mount and CO2 device. Confirm the presence of CO2 and begin ventilating the patient. If in a cardiac arrest scenario, you can now provide continuous ventilations. Move any of the unused equipment a safe distance away where it doesn’t get in your way but is close enough to grab again if needed.

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