FIBEROPTIC INTUBATION - cont'd info

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Step 1: Consider procedural sedation,
antisialogogue,and topical anesthetic prior to
procedure. Then insert lubricated size 7 ETT
into most patent nostril to depth of 11cm.

Step 2: Insert fiberoptic scope into
proximal end of endotracheal tube.

Step 3: Navigate tip of scope by watching
monitor and using control lever and twisting
motion to advance.

Step 4: Once vocal cords are visualized,
deliver 1ml of 4% lidocaine through working
channel port to anesthetize cords. Then use
control lever and twisting motion to advance
scope through vocal cords.

Step 5: Advance scope into trachea and
confirm position by visualizing tracheal rings,
then carina on monitor.

Step 6: Once scope is confirmed in the trachea,
advance endotracheal tube over the fiberoptic
scope to approximately 27cm.

Step 7: Remove fiberoptic scope and attach end
tidal CO2 indicator and bag valve mask. Confirm
endotracheal intubation by listening to breath
sounds and watching purple to yellow color
change on CO2 indicator.

AWAKE ORAL INTUBATION: Predicted Difficult Airway

  1. ANTISIALOGOGUE—Glycopyrolate 0.4 mg IV push, onset 15 minutes
  2. SUCTION Airway and Dry Tongue with 4X4’s
  3. VISCOUS LIDOCAINE LOLLIPOP—coat tongue and post pharynx with Tongue Depressor X 2
  4. SKIP STEPS 1-3 IF RAPID SEQUENCE AWAKE INTUBATION REQUIRED
  5. TOPICALIZE AIRWAY—5cc of 4% lidocaine using MADGIC ATOMIZER– Tongue, Soft Palate, T Pillars X 2
  6. TOPICALIZE CORDS/SUBGLOTTIC AREAS—3cc of 4% Lidocaine via MADGIC Atomizer
  7. CONSIDER SEDATION—Ketmine 10 mg aliquots, Versed 1-2mgs, Zofran 8 mg IVP
  8. Consider Full Dissociation with Ketamine 1mg/kg if agitation an issue
  9. POSITION PATIENT (ear-sternal notch), PREOXYGENATE WITH HIGH FLOW NC, 15 L NRB, WRIST

RESTRAINTS

  1. ATTEMPT INTUBATION—Back Up Plan, Mark Cricothyroid Incision and Surgical Airway Supplies at Bedside
  2. POST INTUBATION SEDATION PLAN–Ready
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