Airway management is the top priority of any EMT or medical staff. If a patient stops breathing, their airway must be preserved to facilitate artificial respiration. In an emergency and hospital setting, two tools stand above the available options in maintaining a patient’s airway in an respiratory emergency; the endotracheal tube and the dual lumen combitube.
The Endotracheal tube is an airway management device used in both emergency and surgical medicine settings. Depending on manufacturer, an ET tube ranges from twenty four to twenty seven centimeters in length and varies in width per patient age, size, and gender. The distal end is fitted with a universal adapter for a bag valve mask connection and pilot balloon that indicates cuff inflation at the proximal end. The opposite end has two openings, one directly at the end of the device and another just up the shaft in the side. This allows for airflow if the proximal opening becomes occluded with a foreign object or bodily substance The device itself is flexible to certain extent, light weight, and sterile when first out of packaging.
Placement of the airway requires a mix of precision, anatomic knowledge, and hours of training. For the purpose of this essay, the description of the EMT placement will be in accordance with the author’s local medical protocols and performed on a pulseless and apneic (not breathing) patient. The EMT first adheres to body isolation precautions with use of surgical mask, goggles, and gloves. The patient is placed into a “sniffing” position with the nose pointing up and opens the mouth by pushing gently on the mouth. The correct tube size is selected, a plastic covered wire is inserted inside the tube for added structural support, and a ten cc syringe is secured into the deflated pilot balloon. The tube is held in the left hand during insertion.
Insertion begins with the patient’s tongue swept to the left side of the mouth with the blade of laryngoscope. The laryngoscope is the intubation tool used to lift the epiglottal opening of the trachea permitting passage of the tube. The blade bypasses the tongue and is placed on the vallecular tendon, just anterior to the epiglottis for a curved blade, or directly on the epiglottis with a straight blade. The blade is lifted and then the tube is inserted into the trachea. The laryngoscope and support wire is removed, the pilot balloon is filled with 10cc of air and patient is assessed for proper tube placement. This is done by attaching a bag valve mask to the accessible opening and squeezing the bag, watching for equal rising of the both sides of the chest. Placement of an expiration carbon dioxide sensor on the valve mask and auscultation of the chest with a stethoscope are also means of proper tracheal intubation. Once an ET tube is properly positioned it is secured with either medical tape purpose manufactured securing rig and ventilation of patient begins.