Advanced Trauma Life Support ATLS Student Course Manual 2018

341
APPENDIX G n Skills
STEP 5.
Connect the laryngoscope blade to the handle,
and check the light bulb for brightness.
STEP 6. Assess the patient’s airway for ease of
intubation, using the LEMON mnemonic.
STEP 7.
Direct an assistant to restrict cervical motion.
The patient’s neck must not be hyperextended
or hyperflexed during the procedure.
STEP 8. Hold the laryngoscope in the left hand.
(regardless of the operator’s dominant hand).
STEP 9. Insert the laryngoscope into the right side of
the patient’s mouth, displacing the tongue
to the left.
STEP 10. Visually identify the epiglottis and then
the vocal cords. External laryngeal manipulation
with backward, upward, and
rightward pressure (BURP) may help to
improve visualization.
STEP 11. Gently insert the ETT through the vocal cords
into the trachea to the correct depth without
applying pressure on the teeth, oral tissues
or lips.
STEP 12. If endotracheal intubation is not accomplished
before the SpO 2
drops below 90%,
ventilate with a bag-mask device and change
the approach [equipment, i.e., gum elastic
bougie (GEB) or personnel].
STEP 13. Once successful intubation has occurred,
apply bag ventilation. Inflate the cuff with
enough air to provide an adequate seal. Do
not overinflate the cuff.
STEP 14. Visually observe chest excursions with
ventilation.
STEP 15. Auscultate the chest and abdomen with a
stethoscope to ascertain tube position.
STEP 16. Confirm correct placement of the tube by
the presence of CO 2
. A chest x-ray exam is
helpful to assess the depth of insertion of
the tube (i.e., mainstem intubation), but it
does not exclude esophageal intubation.
STEP 17. Secure the tube. If the patient is moved,
reassess the tube placement.
STEP 18. If not already done, attach a pulse oximeter to
one of the patient’s fingers (intact peripheral
perfusion must exist) to measure and
monitor the patient’s oxygen saturation
levels and provide immediate assessment of
therapeutic interventions.
Part 3: Pediatric Airway and Cricothyrotomy
Skills Included in This
Skill Station
••
Infant Endotracheal Intubation
••
Needle Cricothyrotomy
••
Surgical Cricothyrotomy with Jet Insufflation
InfANt EndotRAcheal
iNtubation
STEP 1. Ensure that adequate ventilation and
oxygenation are in progress and that
suctioning equipment is immediately
available in case the patient vomits.
STEP 2. Select the proper-size tube, which should be
the same size as the infant’s nostril or little
finger, or use a pediatric resuscitation tape
to determine the correct tube size. Connect
the laryngoscope blade and handle; check
the light bulb for brightness.
STEP 3. Direct an assistant to restrict cervical
spine motion. The patient’s neck must not
be hyperextended or hyperflexed during
the procedure.
STEP 4. Hold the laryngoscope in the left hand
(regardless of the operator’s dominant hand).
STEP 5. Insert the laryngoscope blade into the right
side of the mouth, moving the tongue to
the left.
n BACK TO TABLE OF CONTENTS