Performing Endotracheal Intubation

Performing Endotracheal Intubation

You are at the mall early in the morning and there are dozens of mall walkers. These are people of different ages, twenties, thirties, all the way up to the age of eighty. One man in particular catches everyone’s eye. He is a person possibly near the age of forty who suddenly grasps his chest and collapses to the floor. People rushed to his side only to discover that this man had no pulse and he is not breathing. Cardiopulmonary resuscitation is initiated by a bystander and the paramedics were summoned. When we arrived on scene, there was a flurry of activity as the man’s life hung in the balance. His pulse is restored, but he still is not breathing and his color is different shades of blue. There must be a way to get air into his lungs or he will die. “Shall we intubate?”, Michelle asks me. She was new as a paramedic and was not quite adept yet at making decisions. “What does intubate mean?”, the man’s walking companion was frantically asking as he knelt down beside us for answers. Trying to calm the man’s friend, I told him that we would tell him step by step what we would be doing.

First of all, we explained, endotracheal intubation is a procedure that is performed on a person to maintain an airway when they are unconscious. Endo means inside and tracheal is a person’s trachea, the passageway to where oxygen is transported into the lungs. Intubation means a tube is put into place in the trachea. Essentially what is happening, a person is receiving a tube so they are getting enough oxygen to maintain life. If oxygen is not restored to a person who stops breathing within four to six minutes, they will die. Endotracheal intubation, if performed quickly and correctly, will allow a person to not only maintain their airway, but will prevent certain death. Also, if there are any secretions in the person’s lungs, an endotracheal tube will allow medical personnel to use suction to remove those secretions.

When endotracheal intubation is done, there are several pieces of equipment that are needed. We carefully reached into our jump kit and pulled out the equipment we would need for the procedure. A bag valve mask was shown to the bystanders. It is used to give oxygen before we actually place a tube into the patient. It is helpful if it is hooked up to a tank of oxygen, but it works fine if you don’t have a tank available. You place the mask over the patient’s mouth and nose and then you squeeze the balloon on the end with your hands. This forces air into the lungs.

The second piece of equipment needed for endotracheal intubation is a laryngoscope. A laryngoscope allows us to see what we are doing when we are performing intubations. It has a long handle and a blade is attached to the end of the handle. On the blade is a small light bulb that lights up when placed on the handle. It can be straight or curved depending on the rescuer’s preference and it actually is inserted into the patient’s throat. I myself prefer the straight blade for seeing what I am doing. The blade is not sharp, but it allows the epiglottis that covers the trachea to be pulled up so an endotracheal tube can be put into place.

There are several other pieces of equipment needed during endotracheal intubation. Obviously, an endotracheal tube is needed. Depending on the size of the patient, there are different sizes of tubes. A ten milliliter syringe allows for the balloon at the end of the tracheal tube to be inflated once it is in place. An inflated balloon will make the tube stay in place and not slip out. As stated earlier, a bag valve mask device is needed as well to attach to the end of the endotracheal tube to force air into the lungs. Lungs need to be auscultated or listened to after intubation so a stethoscope will suffice for that.

With all the equipment gathered, it is now time to save the patient. The patient should be on their back (which ours was), and one of us should go to the patient’s head. I will place the laryngoscope in my left hand and then attach the appropriate blade to it and make sure the light bulb is in working order. The patient’s mouth is then opened and the blade is inserted into the right side of the mouth and is slid to the center pushing the tongue out of the way.

Once the blade is in the right depth, the blade is hoisted up at a forty degree angle lifting the epiglottis. The vocal cords should then be visible. When I can see the vocal cords, I take the endotracheal tube in my right hand and slide it between them. The tube then will be in the trachea. The laryngoscope is then removed, but the tube remains and is held by Michelle until it is secured.

The ten milliliter syringe is then attached to the tube and air is expelled into the balloon to inflate it. The bag valve is now attached to the end of the endotracheal tube, and air is squeezed from the