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Tracheal intubation - 3

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VOL: 98, ISSUE: 04, 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

Once a tracheal tube has been inserted it is essential to confirm it has been inserted correctly. Incorrect placement of the tube in the oesophagus can lead to hypoxia and death (Skinner and Vincent, 1997), and incorrect placement in the right main bronchus will result in ineffective ventilation.

There are various ways to check if the positioning of the tube is correct. Unfortunately it is sometimes difficult to confirm its position, even with modern technology such as an expired CO2 detector. The advice is: 'If in doubt, take it out' (Resuscitation Council (UK), 2000). Even if correct tube placement is confirmed, it is still important continually to monitor its position and the effectiveness of ventilation while the patient remains intubated.

The mnemonic DOPE offers a useful way of remembering the reasons for ventilation becoming ineffective or difficult:

- Displaced tube: either into the pharynx/oesophagus or right/left main bronchus

- Obstructed tube: causes could include vomit, blood, secretions and tube kinking

- Pneumothorax

- Equipment failure: for example, accidental disconnection of equipment, empty oxygen cylinder.

The regular checks that routinely follow tracheal intubation should detect any of the above problems.

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