How to Master Tracheal Intubation

  1. Preparation
    a. Select the right blade size.
    b. Shape the stylet and ETT straight to the cuff, then bend at a 30-35 degree angle.
    c. Properly position the patient Ear-to-Sternal-Notch with face plane parallel to ceiling.
  2. Epiglottoscopy
    a. Progressively and methodically advance the tip of the blade midline and gently seat in the vallecula.
  3. Laryngeal Exposure
    a. If the view is still not optimal, consider trying ELM, or HELP to improve visualization.
  4. Tube Delivery
    a. Using straight-to-cuff shaping, insert near the right corner of the mouth and advance upward.
    b. Pass the tip anterior to the interarytenoid notch.
    c. Ensure the cuff of the tracheal tube is below the level of the cords.
  5. Tube Confirmation and Maintenance
    a. Direct visualization
    b. Absent sounds over the epigastrium
    c. Equal bilateral breath sounds
    d. Good compliance with the BVM
    e. Tube fogging (never primary)
    f. Continuous waveform capnography (for confirmation and maintenance)
    g. Rising SpO2 (for patients with a pulse)

EMKF

The Emergency Medicine Kenya (EMK) Foundation is a not-for-profit organization registered in Kenya in 2015 that aims to ensure timely, accessible and quality lifesaving emergency care in Kenya.