Equipment 8-288 - Endotracheal Tube (ET)

CMH EMS & MIH Protocols

Scope of Practice:

Registered Nurse

Paramedic

Indications:

Contraindications:

None.

Precautions:

Can induce Hypertension and increase ICP in Head injured patients.

Can induce Vagal response and Bradycardia.

Can induce hypoxia-related arrhythmias.

Cuffed ET tubes are preferred over un-cuffed for all tube sizes and patient ages.

Routine use of cricoid pressure is not recommended for pediatric patients.

Procedure:

Hyperventilate with BVM and basic adjunct.

Assemble, check, and prepare equipment.

Consider Neo-Synephrine (2-3 sprays in each nare) for nasal intubation.

Consider iGel for backup airway.

Place head in sniffing position (maintain c-spine in trauma).

Insert Laryngoscope blade.

Sweep tongue to the left.

Lift forward to displace jaw.

Advance tube past vocal cords until the cuff disappears.

Adult: Inflate cuff with 7-10 ml of air. If able, check inflation pressure between 20-25 cm H2O.

Pediatric: Inflate only enough to stop air leakage. Balloon should be pliable and soft.

Ventilate and confirm placement with auscultation and Capnography.

Secure tube, noting marking on tube.

Consider: Insert OPA as a bite block.

Ventilate with 100% Oxygen.

Reassess tube placement often.

Continued sedation:

Refer to Protocol 2-044 - Airway:RSI

Consider Gastric Tube.

Citations:

Protocol 9-010 - References
American Heart Association, 2020

Change Log:

Date	Link to previous version	Description of change
11/30/-1	pdf	Added indication for Protocol 6-085 - High-Threat Response.
04/03/15	pdf	Added Consider Neo-Synephrine and Consider King
04/05/19	pdf	Added dose of 2-3 sprays in each nare for neo-synephrine. APPROVED BY DR. CARTER 4/5/19.
07/04/20		Renumbered the section to allow for future additions.
08/07/20	pdf	Added content (without substantive modification) from old Section 8-080 - Endotracheal Tube (ET).
02/22/21	pdf	Added indications for Cardiac Arrest and Post Resuscitation. Added AHA 2020 updates to include cuffed is preferred over un-cuffed, routine pediatric cricoid pressure is not recommended, and maintain cuff inflation pressure between 20-25 cm H2O.
06/11/21	pdf	Moved to emsprotocols.online
12/01/21		Updated link to Versed.
03/19/23		Changed link for Neosynephrine
03/20/23		Changed link for Fent.

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."