Standards Procedure (Skill)
Clinical Indications: Levels: EMT-I & EMT-P
Ø An unconscious patient without a gag reflex who is apneic or is demonstrating inadequate respiratory effort or is unable to control their airway.
Ø Any patient medicated for rapid sequence intubation.
Procedure:
a. Prepare all equipment and have suction ready.
b. Preoxygenate and hyperoxygenate the patient.
c. Open the patient’s airway. While holding the laryngoscope in the left hand, insert the blade into the right side of the patient’s mouth sweeping the tongue to the left.
d. Use the blade to lift the tongue and the epiglottis (either directly with the straight (Miller) blade or indirectly with the curved (Macintosh) blade.
e. Once the glottic opening is visualized, insert the tube through the vocal cords and continue to visualize while passing the cuff through the cords.
f. Remove the stylet from the tube and inflate the cuff of the tube by inserting 5-10cc of air.
g. Auscultate for bilateral equal breath sounds and absence of epigastric sounds. This should be repeated often especially after movement of the patient.
h. Confirm the placement of the tube by using an end-tidal CO2 detector or esophageal bulb device.
i. Secure the tube.
j. Document the ETT size, time, results, and placement location (in cm at the level of the patient’s teeth or gums) on the ACR. Also include in documentation the procedures and devices used for confirmation of the tube.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.