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Tracheal intubation - 1 Preparation

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VOL: 98, ISSUE: 02, PAGE NO: 43

PHIL JEVON, RESUSCITATION OFFICER, MANOR HOSPITAL, WALSALL; JAGTAR SINGH POONI, CONSULTANT IN ANAESTHESIA AND INTENSIVE CARE, CITY HOSPITAL, BIRMINGHAM

PHIL JEVON, RESUSCITATION OFFICER, MANOR HOSPITAL, WALSALL; JAGTAR SINGH POONI, CONSULTANT IN ANAESTHESIA AND INTENSIVE CARE, CITY HOSPITAL, BIRMINGHAM

Tracheal intubation is the gold standard for securing a patient's airway during cardiopulmonary resuscitation (CPR). During ventilation, intubation reduces the risk of gastric distension and the associated hazard of regurgitation of gastric contents, both of which are not uncommon with mask ventilation. A cuffed tracheal tube will prevent aspiration of gastric contents (Simons, 1999).

Tracheal intubation enables suction of the trachea and lower airways, the delivery of high concentrations of inspired oxygen, effective ventilation (even when resistance in the airways is high, for example, bronchospasm), mechanical ventilation, and the delivery of some emergency drugs, for example, epinephrine (adrenaline) (Resuscitation Council (UK), 2000).

The procedure requires expertise and experience because it can be difficult and sometimes hazardous. Multiple or failed intubation attempts by inexperienced practitioners may adversely affect the outcome of the CPR attempt (Resuscitation Council (UK), 2000).

'Time out' for tracheal intubation, that is, when the patient is not being oxygenated, should be kept to a minimum and certainly should not exceed 30 seconds (Resuscitation Council (UK), 2000). Adequate preparation before the procedure is therefore essential. In particular, all the necessary equipment should be at hand and checked to ensure it is in good working order.

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