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• Endotracheal tube (ETT)


  Semi-rigid tube and composed of polyvinyl chloride or related plastic polymers
• Endotracheal tube (ETT)


  Semi-rigid tube and composed of polyvinyl chloride or related plastic polymers
• Types of ETT


  • Regular (uncuffed)
  • Regular Cuffed
  • ETT with Subglottic suction
  • Reinforced/ armored tube
  • RAE/ preformed tube
• Cuffed ETT


  • Used with most patients (children > 8 years)
  • Advantages: Maintain the tube in proper position, Make good sealing and prevent leakage, Prevent aspiration
• Uncuffed ETT


  Used with children < 8 years
• Types of ETT


  • Regular (uncuffed)
  • Regular Cuffed
  • ETT with Subglottic suction
  • Reinforced/ armored tube
  • RAE/ preformed tube
• Cuffed ETT


  • Used with most patients (children > 8 years)
  • Advantages: Maintain the tube in proper position, Make good sealing and prevent leakage, Prevent aspiration
• Uncuffed ETT


  Used with children < 8 years
• Routes of Intubation


  • Oral
  • Nasal
• Routes of Intubation


  • Oral
  • Nasal
• Oral intubation


  • The most common and preferred route of insertion
  • Can use large tube which decrease the resistance
• Oral intubation


  • The most common and preferred route of insertion
  • Can use large tube which decrease the resistance
• Nasal intubation


  • Preferred in patients with maxillofacial injuries
  • Have to use small tubes which increase the resistance
• Proper size of ETT

  • Male: 21 cm at lip level
  • Female: 19 cm at lip level
  • Initial depth of insertion: ETT size * 3
• Nasal intubation


  • Preferred in patients with maxillofacial injuries
  • Have to use small tubes which increase the resistance
• Airway Assessment


  • LEMON
  • Mallampati score
• Proper size of ETT

  • Male: 21 cm at lip level
  • Female: 19 cm at lip level
  • Initial depth of insertion: ETT size * 3
• Intubation


  • The process of inserting an endotracheal tube through the mouth/nose then into the trachea
  • Indications: Upper airway obstruction, Cardiac arrest, Respiratory Failure, Protect the airway from aspiration, Facilitate mechanical ventilator
• Airway Assessment


  • LEMON
  • Mallampati score
• Intubation


  • The process of inserting an endotracheal tube through the mouth/nose then into the trachea
  • Indications: Upper airway obstruction, Cardiac arrest, Respiratory Failure, Protect the airway from aspiration, Facilitate mechanical ventilator
• Intubation Complications


  • Vocal cord damage
  • Upper airway edema
  • Mucosal damage
  • Tracheal stenosis
  • Sore throat and hoarseness
• Intubation Complications


  • Vocal cord damage
  • Upper airway edema
  • Mucosal damage
  • Tracheal stenosis
  • Sore throat and hoarseness
• Intubation while performing chest compression?
• Intubation while performing chest compression?
• Intubation Equipment


  • Laryngoscopes (Miller, Macintosh)
  • Stylet
  • Bougie
  • Magill Forceps
  • Colorimetric CO2 Detector
• Intubation Equipment


  • Laryngoscopes (Miller, Macintosh)
  • Stylet
  • Bougie
  • Magill Forceps
  • Colorimetric CO2 Detector
• Stylet


  Plastic covered metal wire used to hold up the tube in desired shape
• Stylet


  Plastic covered metal wire used to hold up the tube in desired shape
• Bougie


  Differs from stylet
• Bougie


  Differs from stylet
• Magill Forceps


  • To remove foreign bodies
  • To re-direct tube during nasal Intubation
• Colorimetric CO2 Detector


  • Attaches directly to the endotracheal tube and responds quickly to exhaled CO2 by changing from purple to yellow
  • Made of pH sensitive paper
• Magill Forceps


  • To remove foreign bodies
  • To re-direct tube during nasal Intubation
• Oral Intubation


  1. Step 1: Assemble and Check Equipment

  2. Step 2: Position Patient

  3. Step 3: Preoxygenate and Ventilate Patient

  4. Step 4: Insert Laryngoscope

  5. Step 5: Visualize Glottis

  6. Step 6: Displace Epiglottis

  7. Step 7: Insert Tube

  8. Step 8: Assess Tube Position

  9. Step 9: Stabilize Tube and Confirm Placement
• Colorimetric CO2 Detector


  • Attaches directly to the endotracheal tube and responds quickly to exhaled CO2 by changing from purple to yellow
  • Made of pH sensitive paper
• Assemble and Check Equipment

  • All suction equipment is assembled, and the vacuum pressure is checked
  • The appropriate size laryngoscope blade is attached to its handle, and the light source is checked for secure attachment and brightness
  • An appropriate size tube should be selected, and other tubes should be available that are at least one size larger and one size smaller
  • The cuff must be tested using a syringe for any leaks by inflating and deflating it
  • Many clinicians insert a stylet into the tube to add rigidity and maintain shape during insertion
• Oral Intubation


  1. Step 1: Assemble and Check Equipment

  2. Step 2: Position Patient

  3. Step 3: Preoxygenate and Ventilate Patient

  4. Step 4: Insert Laryngoscope

  5. Step 5: Visualize Glottis

  6. Step 6: Displace Epiglottis

  7. Step 7: Insert Tube

  8. Step 8: Assess Tube Position

  9. Step 9: Stabilize Tube and Confirm Placement
• Position Patient


  To visualize the glottis and insert the tube, the RT aligns the patient's mouth, pharynx, and larynx in the sniff position
• Assemble and Check Equipment

  • All suction equipment is assembled, and the vacuum pressure is checked
  • The appropriate size laryngoscope blade is attached to its handle, and the light source is checked for secure attachment and brightness
  • An appropriate size tube should be selected, and other tubes should be available that are at least one size larger and one size smaller
  • The cuff must be tested using a syringe for any leaks by inflating and deflating it
  • Many clinicians insert a stylet into the tube to add rigidity and maintain shape during insertion
• Preoxygenate and Ventilate Patient

  • Providing ventilation and oxygenation by manual resuscitator bag and mask with 100% O2 before intubation
  • Using CPAP
  • Using HFNC
  • No more than 30 seconds should be devoted to any intubation attempts
  • If intubation fails, immediate ventilation and oxygenation of the patient for 3 to 5 minutes before the next attempt should occur