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Orotracheal Intubation

Clinical Indications:

    Any patient without a gag reflex who is apneic or is demonstrating inadequate respiratory effort.
    Any patient medicated for rapid sequence intubation or sedated airway control.

Procedure:

    1. Prepare all equipment and have suction ready.
    2. Preoxygenate and position the patient.
    3. Open the patient's airway and holding the laryngoscope in the left hand, insert the blade into the right side of the mouth and sweep the tongue to the left.
    4. Use the blade to assist in visualizing the vocal cords (either directly with the straight blade or indirectly with the curved blade).
    5. Once the glottic opening is visualized, insert the lubricated tube through the cords and continue to visualize until the cuff is past the cords or until the intubation depth marker is equal to the vocal cords.
    6. Remove the stylet and inflate the cuff with enough air to make a seal.
    7. Auscultate for absence of sounds over the epigastrium and bilaterally equal breath sounds. This should be repeated frequently and after movement or manipulation.
    8. Confirm the placement using direct visualization, EDD, epigastric and breath sounds symmetrical chest rise, capnograph, and bag compliance.
    9. Secure the tube and apply C-collar.
    10. Document ETT size, time, result (success), and placement location by the centimeter marks either at the patient's teeth or lips on the patient care report (PCR). Use all devices to confirm initial tube placement and document. Reassess and document after each patient movement, electrical therapy, change in bag compliance, change in Pt status, and transfer of Pt care at the hospital.
    11. Attach ventilator. (See ventilator procedure).
    12. Insert NG\OG tube

Certification Requirements:

    Successfully complete an annual skill evaluation inclusive of the indications, contraindications, technique, and possible complications of the procedure.

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