Introduction into the trachea special tube called intubation. This operation has a number of technical difficulties, but they outweigh the advantages of this method when providing emergency assistance to the patient in a serious condition at the prehospital stage.
- easy managed or auxiliary breathing;
- patient in any position, provided the normal patency of the airway;
the inability of suffocation as a result of aspiration of vomitus, detritus, mucus, blood, foreign bodies, acute ligament;
- the possibility of aspiration of the bronchi and trachea;
- the possibility of extending areas of lungs exposed to atelectasis;
the best conditions for the solution of pulmonary edema and so on.
Tracheal intubation is performed during the swelling of the lungs, is the object of the trachea, severe poisoning (by disturbance of breathing), end-stage respiratory failure and so on. The contraindications to this manipulation are pathological abnormalities in the facial Department of the skull deformity, ankylosis or contracture of maxillo-temporal replacement), diseases of the neck of an inflammatory nature, damage to the cervical part of the spine.
There are two completely different ways of carrying out the manipulation. You can perform the intubation of patients with preserved consciousness, when they are actively involved in this process. With this method, a tube is inserted through the mouth or nose, with a preliminary local anaesthetic procaine or dikaina. The patient begins to breathe deeply and inhale it through the glottis promoting the tube. If the tube went in easily, but breathing through her no, so she got into the esophagus. In this case produce a partial extraction tube, the maximum unbend the patient's head and by mouth with a finger, install the tube in the right place. The second method is to carry out intubation by direct laryngoscopy. This method is used in patients who are in a coma or in cases of diplegia and General anesthesia. The method of choice, of course, is the second option for intubation. The first applies only in cases of emergency (anatomic features of the patient, the impossibility of pre-anesthetic, the lack of suitable conditions for carrying out laryngoscopy). Intubation will be successful only if the patient horizontally on the back. The head should be flatten and place a cushion under it (the hat or folded clothes or a small pillow. The doctor, holding in his right hand laryngoscope, opens the mouth of the patient by the fingers of the left hand and visually monitoring the process, gently holds the laryngoscope blade on the back of the tongue, pushing the tongue to the left. Then he takes the laryngoscope in the left hand and begins to push it forward to enter into the trachea.
If the patient is breathing on their own, the tube introduced him to breath. The appearance of the tube, a jet of air and the presence of light over respiratory noise indicates the accuracy of the intubation. Rapid onset of cyanosis, absence of noise above the light and the characteristic noise in the area of the stomach suggests that the pipe got into the esophagus. In this case it is taken, light for five minutes ventilate with 100 % oxygen until the disappearance of cyanosis and again try to enter the tube. After the introduction it is fixed around the head of the patient by tape or adhesive. To the stretcher, clothing and other items to attach tube is strictly prohibited!
Possible complications of intubation: suffocation due to kinking of the tube, esophageal rupture, damage to teeth, hypercapnia and hypoxia, impaired heart (asystole, extrasystoles, bradycardia), broncho and laryngospasm, damage to mucous membranes.