Intubation Procedure Note [.phrase]

Endotracheal Intubation Note

RRT called patient in respiratory distress, at bedside obvious respiratory distress/impending respiratory failure, patient unable to speak >1 word, accessory respiratory muscle use apparent. Tachycardic to 140-150's, SaO2 68% on monitor. Intubation indicated for active respiratory failure.

Preoxygenation with 100% O2 via NRBR/ambubag achiving 91% O2 sat prior to intubation. Easy bag mask ventilation.

Sedation with 2mg ativan and 20mg of etomidate inducing sufficient anesthesia for intubation

DLx1 Mac 4

Copious clear oropharyngeal secretions noted requiring aggressive suction with Yankauer suction catheter,

Large tongue made initial visualization of the VC difficult

Grade 3 view of VC improved to grade 2 view with BURP pressure. No laryngospasm/foreign bodies or apparent secretions distal to VC

Again, secretions appeared clear but cannot rule out aspiration given the volume of secretions encountered.

7.0 cuffed ET passed atraumatically through the VC, ETCO2+, BSEB, tube secured at 23cm at the lip

CXR showing tracheal placement of ETT above the carina, noted bilateral infiltrates on CXR pulmonary edema in appearance.

Patient should be known as a potentially difficult airway for the following reasons:

1. anatomically anterior airway requiring BURP pressure,

2. large tongue which is prone to obstructing view.

Christian Castaneda, MD

Pulmonary and Critical Care Medicine