Tracheal Intubation

permits a tight seal over both the mouth and nose. They should not have a pop-off valve as

sometimes high pressures are needed.

The main goal of ventilation is to maintain oxygenation. This is evidenced as having a pulse

oximeter saturation of O2 of 90 percent or greater. If it isn’t working, check the seal, use of jaw

thrust, insertion of oral airway or nasal airway, and mask size. Suction the airway if needed.

Squeeze the 1-liter bag about two-thirds of the way for a minimum of 600 cc (up to 800 cc) per

squeeze.

From a physiological perspective, the BVM ventilation is positive pressure ventilation versus the

negative pressure ventilation used by people normally. It forces air into the lungs instead of

having air drawn into them. The main side effect is decreased cardiac output from reduced

venous return to the right side of the heart—made worse in hypovolemia. This is why

ventilation should be minimized in CPR.

Another downside to BVM ventilation is barotrauma—most commonly the pneumothorax. This

comes from delivering higher than normal tidal volumes during BVM ventilation. Gastric

distention and gastric perforation can also occur.

TRACHEAL INTUBATION

In some cases, tracheal intubation cannot be done. Some patients respond to a double lumen

device instead, which can be blindly inserted with less skill than required for a tracheal

intubation. It involves the placement of a flexible tube into the trachea in order to have a

protected airway. It mainly allows for ventilation but also is a conduit for the administration of

certain drugs.

In the conscious or semi-conscious patient, it requires general anesthesia and a neuromuscular

blocking drug or a strong local anesthetic. It requires a laryngoscope, flexible fiberoptic

bronchoscope, or a video laryngoscope in order to place the device safely. These allow for

visualization of the vocal cords, through which the ET tube passes.