Standards Procedure (Skill)
Clinical Indications: Level: EMT-P only
Ø A spontaneously breathing patient in need of intubation (inadequate respiratory effort, evidence of hypoxia or carbon dioxide retention, or need for airway protection.)
Ø Patient must be 12 years of age or older.
Procedure:
a. Premedicate the patient with nasal spray.
b. Select the largest and least obstructed nostril and insert a lubricated nasal airway to help dilate the nasal passage.
c. Preoxygenate the patient. Lubricate the tube.
d. Remove the nasal airway and gently insert the tube keeping the bevel toward the septum (a gentle rotation movement may be necessary at the turbinates.)
e. Continue to pass the tube while listening for maximum air movement.
f. The point of maximum air movement indicates the level of the glottis, gently and evenly advance the tube through the glottic opening on inspiration.
g. Upon entering the tube may cause the patient to cough, buck, strain, or gag. Do not remove the tube for this is normal. Be prepared to control the cervical spine and the patient, and be alert for vomiting.
h. Auscultate for bilateral equal sounds and absence of epigastric sounds. Observe for symmetrical chest expansion. The 15mm usually rests close to the nostril with proper positioning.
i. Inflate the cuff with 5-10 cc of air.
j. Confirm tube placement using an end-tidal CO2 monitoring or esophageal bulb device.
k. Secure the tube.
l. Document the procedure, time, and results on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.