Optional, AEMT

Course Objectives
Describe Sellicks maneuver and the use of
cricoid pressure during intubation.
Describe the necessary equipment needed to
perform orotracheal intubation.
Describe the indications, advantages,
disadvantages, and complications of
orotracheal intubation.
Describe the visual landmarks for direct
laryngoscopy.

Course Objectives
Describe steps to perform orotracheal
intubation.
Describe the methods of assessing, confirming,
and securing correct placement of an
orotracheal tube.
Describe the technique for extubation.

Sellicks Maneuver
Helps prevent regurgitation and reduces gastric
distention.
Locate the cricoid cartilage by palpating the
thyroid cartilage and the feel the depression just
below it (cricothyroid membrane).
Using your thumb and index finger of one hand,
apply pressure to the anterior and lateral
aspects of the cricoid cartilage just next to the
midline.
See picture on next slide.
Sellicks Maneuver
Airway Before Applying
Sellicks
Airway with Sellicks Applied
(Note compression on the esophagus.)
Oraltracheal Intubation
Equipment
Laryngoscope handle and blade
Endotracheal tube
10 ml syringe
Stylet
BVM
Suction device
Bite block
Magill forceps
Tape or tube-holding device
Laryngoscope Blades
Engaging Laryngoscope
Blade and Handle
Activating Laryngoscope
Light Source
Placement of Macintosh
Blade into Vallecula
Placement of Miller Blade
under Epiglottis
Endotracheal Tube
5.0 mm-9.0 mm (cuffed)
Distal end has a beveled
tip for smooth movement
through airway passages.
Length ranges from 12cm-
32cm.
Typical size for an average
adult male is 7.5-8.5 mm
Typical size for an average
adult female is 7.0-8.0 mm

Tube and Syringe
Tube, Stylet, and Syringe,
Unassembled
Tube, Stylet, and Syringe,
Assembled for Intubation
Magill Foreceps
Tube-Holding Device
Oraltracheal Intubation
Indicators
Respiratory or cardiac arrest
Unconsciousness
Risk of aspiration
Obstruction due to foreign bodies, trauma,
burns, or anaphylaxis
Respiratory extremis due to disease
Pneumothorax, hemothorax,
hemopneumothorax with respiratory
difficulty

Advantages of
Oraltracheal Intubation
Isolates trachea and permits
complete control of airway
Impedes gastric distention
Eliminates need to maintain a mask seal
Offers direct route for suctioning
Permits administration of some medications

Disadvantages of
Endotracheal Intubation
Requires considerable training and experience
Requires specialized equipment
Requires direct visualization of vocal cords
Bypasses upper airways functions
of warming, filtering, and humidifying the
inhaled air

Complications of
Oraltracheal Intubation
Equipment malfunction
Teeth breakage and soft tissue lacerations
Hypoxia
Esophageal intubation
Endobronchial intubation
Tension pneumothorax

Visual Landmarks
Hyperventilate the patient
Prepare and Test
Equipment
Apply Sellicks maneuver
and insert laryngoscope
Visualize glottis through
laryngoscopy
Inflate cuff, ventilate,
and auscultate
Confirm placement with an
ETCO
2
detector
Secure tube
Reconfirm tube placement


Field Extubation
Prepare intubation equipment and suction
Confirm patient responsiveness
Suction the patients oropharynx
Deflate the cuff
Remove the tube upon cough or expiration
Provide supplemental oxygen as needed
Reassess the adequacy of the patients
ventilation and oxygenation
Summary
Sellicks manuever
Necessary equipment to perform orotracheal
intubation
Indications, advantages, disadvantages, and
complications of orotracheal intubation
Visual landmarks
Steps to perform orotracheal intubation
Methods of assessing, confirming, and securing
correct placement of an orotracheal tube
Technique for extubation