The first hard part is getting the tube past the vocal cords in the larynx. This requires the correct positioning of the patient to be able to see the vocal cords. (fibreoptic scope sometimes necessary) and to align structures for easier insertion.
Laryngospasm where the vocal cords come together to block the airway is a major concern. (the vocal cords coming together is a normal part of swallowing to prevent things going into the airways and contacting the cords will induce a spasm.) This can be reduced by using a local anaesthetic spray on the cords—essential if the patient is conscious (a rare situation).
Correct placement of the endotracheal tube is critical. It must be within the trachea, above the carina (where the trachea splits into the main bronchi and definitely not into a lung). If the tube goes into a bronchus it means one lung gets air, the other doesn’t. A bad intubation is worse than no intubation.
For ventilation:
Fancy equipment
or
Someone squeezing a ventilation bag. (+ oxygen supplementation)
But ultimately, nurses/EMTs/medical students can be trained to do all this in a few days. If someone’s competent and confident and has adequate back-up in-case of issues.
But ultimately, nurses/EMTs/medical students can be trained to do all this in a few days. If someone’s competent and confident and has adequate back-up in-case of issues.
I think we might want to be in the world where we train a substantial fraction of the recently unemployed, or the National Guard, or whoever to do this, which requires starting from a lower point than nurses/EMTs/medical students.
There’s a big difference between the process of intubation and maintaining a patient once intubated.
Someone with no prior knowledge of anatomy and physiology intubating patients (even after intense training) would increase the risks to patients. A mistake could be fatal. Time is a crucial factor—less than 4 minutes to correct an issue (brain needing oxygen).
Sedation/paralytic drugs need to be given. Dangerous in themselves. (an old saying re intravenous anaesthetics—dead easy, easily dead)
Adequate supervision/ back-up would be essential.
Aptitude of the trainee would also be very important. No room for getting stressed. 1st rule emergency medicine—breathe.
Better for the more experienced to intubate and then training people on ventilator management / how to squeeze a bag at the right pressure and timing (when ventilators aren’t available).
For intubation:
The patient is usually sedated/unconscious. (drugs need to be administered)
correct insertion of endotracheal tube ( endo ~ inside trachea = windpipe)
The first hard part is getting the tube past the vocal cords in the larynx. This requires the correct positioning of the patient to be able to see the vocal cords. (fibreoptic scope sometimes necessary) and to align structures for easier insertion.
Laryngospasm where the vocal cords come together to block the airway is a major concern. (the vocal cords coming together is a normal part of swallowing to prevent things going into the airways and contacting the cords will induce a spasm.) This can be reduced by using a local anaesthetic spray on the cords—essential if the patient is conscious (a rare situation).
Correct placement of the endotracheal tube is critical. It must be within the trachea, above the carina (where the trachea splits into the main bronchi and definitely not into a lung). If the tube goes into a bronchus it means one lung gets air, the other doesn’t. A bad intubation is worse than no intubation.
For ventilation:
Fancy equipment
or
Someone squeezing a ventilation bag. (+ oxygen supplementation)
But ultimately, nurses/EMTs/medical students can be trained to do all this in a few days. If someone’s competent and confident and has adequate back-up in-case of issues.
I think we might want to be in the world where we train a substantial fraction of the recently unemployed, or the National Guard, or whoever to do this, which requires starting from a lower point than nurses/EMTs/medical students.
There’s a big difference between the process of intubation and maintaining a patient once intubated.
Someone with no prior knowledge of anatomy and physiology intubating patients (even after intense training) would increase the risks to patients. A mistake could be fatal. Time is a crucial factor—less than 4 minutes to correct an issue (brain needing oxygen).
Sedation/paralytic drugs need to be given. Dangerous in themselves. (an old saying re intravenous anaesthetics—dead easy, easily dead)
Adequate supervision/ back-up would be essential.
Aptitude of the trainee would also be very important. No room for getting stressed. 1st rule emergency medicine—breathe.
Better for the more experienced to intubate and then training people on ventilator management / how to squeeze a bag at the right pressure and timing (when ventilators aren’t available).
Tracheal intubation in the ICU: Life saving or life threatening?