Optional, AEMT

Course ObjectivesDescribe Sellick’s maneuver and the use of

cricoid pressure during intubation.Describe the necessary equipment needed to

perform orotracheal intubation.Describe the indications, advantages,

disadvantages, and complications of orotracheal intubation.

Describe the visual landmarks for direct laryngoscopy.

Course ObjectivesDescribe steps to perform orotracheal

intubation.Describe the methods of assessing,

confirming, and securing correct placement of an orotracheal tube.

Describe the technique for extubation.

Sellick’s ManeuverHelps prevent regurgitation and reduces gastric

distention.Locate the cricoid cartilage by palpating the

thyroid cartilage and the feel the depression just below it (cricothyroid membrane).

Using your thumb and index finger of one hand, apply pressure to the anterior and lateral aspects of the cricoid cartilage just next to the midline.

See picture on next slide.

Sellick’s Maneuver

Airway Before Applying Sellick’s

Airway with Sellick’s Applied (Note compression on the esophagus.)

Oraltracheal Intubation EquipmentLaryngoscope handle and bladeEndotracheal tube10 ml syringeStyletBVMSuction deviceBite blockMagill forcepsTape or tube-holding device

Laryngoscope Blades

Engaging Laryngoscope Blade and Handle

Activating Laryngoscope Light Source

Placement of Macintosh Blade into Vallecula

Placement of Miller Blade under Epiglottis

Endotracheal Tube5.0 mm-9.0 mm (cuffed)Distal end has a beveled

tip for smooth movement through airway passages.

Length ranges from 12cm-32cm.

Typical size for an average adult male is 7.5-8.5 mm

Typical size for an average adult female is 7.0-8.0 mm

Tube and Syringe

Tube, Stylet, and Syringe, Unassembled

Tube, Stylet, and Syringe, Assembled for Intubation

Magill Foreceps

Tube-Holding Device

Oraltracheal Intubation Indicators

Respiratory or cardiac arrest Unconsciousness Risk of aspiration Obstruction due to foreign bodies,

trauma, burns, or anaphylaxis

Respiratory extremis due to disease Pneumothorax, hemothorax,

hemopneumothorax with respiratory difficulty

Advantages of Oraltracheal Intubation

Isolates trachea and permitscomplete control of airway

Impedes gastric distention Eliminates need to maintain a mask seal Offers direct route for suctioning Permits administration of some medications

Disadvantages of Endotracheal Intubation

Requires considerable training and experience

Requires specialized equipment Requires direct visualization of vocal cords Bypasses upper airway’s functions

of warming, filtering, and humidifying the inhaled air

Complications of Oraltracheal Intubation

Equipment malfunction Teeth breakage and soft tissue lacerations Hypoxia Esophageal intubation Endobronchial intubation Tension pneumothorax

Visual Landmarks

Hyperventilate the patient

Prepare and Test Equipment

Apply Sellick’s maneuver and insert laryngoscope

Visualize glottis through laryngoscopy

Inflate cuff, ventilate, and auscultate

Confirm placement with an ETCO2 detector

Secure tube

Reconfirm tube placement

Field ExtubationPrepare intubation equipment and suctionConfirm patient responsivenessSuction the patient’s oropharynxDeflate the cuffRemove the tube upon cough or expirationProvide supplemental oxygen as neededReassess the adequacy of the patient’s

ventilation and oxygenation

SummarySellick’s manueverNecessary equipment to perform orotracheal

intubationIndications, advantages, disadvantages, and

complications of orotracheal intubationVisual landmarksSteps to perform orotracheal intubationMethods of assessing, confirming, and

securing correct placement of an orotracheal tube

Technique for extubation