Operational Medicine 2001
Endotracheal Intubation

Ideally, the patient should be hyperventilated with 100% oxygen for several minutes prior to intubation.

Assemble and test equipment while patient is being ventilated:

• Inflate cuff on endotracheal tube with 5-10cc of air and check for leaks, remove air from cuff, leave syringe attached to tube.  

• Insert stylet into ET tube, ensure that it cannot protrude past the distal end of the ET tube.  

• Ensure that the stylet slides out the top of the ET tube easily. 

• Check light on laryngoscope.

• Assure availability of suction.

Lubricate distal end of tube with water soluble lubricant.

Assistant holds pt's head, performs Sellick's maneuver and counts slowly to 30.

Intubator takes a breath and holds it, then directly visualizes cords with laryngoscope.

If unable to visualize chords within 30 seconds, or when the intubator has to take a breath, then remove the laryngoscope and ventilate the patient for 1 minute. Repeat attempt to visualize the cords.

When chords are visualized, advance tube to a depth of 5cm beyond cords.

Inflate cuff and ventilate.

Check the tube placement by listening over the stomach and both lung fields.   Re-position the tube or remove as necessary.  Do not release Sellick’s maneuver until proper position of the tube is confirmed and the cuff is inflated.

Secure the tube with adhesive tape once proper placement is confirmed.

Re-confirm position of tube by listening to the lungs every time the patient is moved.

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Operational Medicine 2001
Health Care in Military Settings

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