Intubation, endotracheal, emergency procedure
CPT4 code
Name of the Procedure:
Endotracheal Intubation (Emergency Procedure)
Summary
Endotracheal intubation is a medical procedure where a tube is inserted through the patient's mouth and into their trachea (windpipe) to maintain an open airway, especially in emergency situations.
Purpose
Endotracheal intubation is primarily performed to ensure that the airway remains open and functional. This is critical for patients who are unable to breathe on their own due to conditions such as severe respiratory distress, unconsciousness, or obstruction of the airway.
Indications
- Severe respiratory distress or failure
- Unconsciousness with compromised airway reflexes
- Airway obstruction due to trauma, allergic reaction, or foreign body
- Cardiopulmonary resuscitation (CPR) in emergencies
- Severe trauma or burns affecting the airway
Preparation
- Typically, no specific preparations as it is an emergency procedure
- Rapid assessment of the airway and patient condition
Procedure Description
- The patient is positioned appropriately (usually flat on their back with the head tilted back slightly).
- A laryngoscope is used to view the vocal cords.
- The endotracheal tube is carefully inserted through the mouth, past the vocal cords, and into the trachea.
- The tube is then secured in place, and correct placement is confirmed through various methods like auscultation and capnography.
- The patient is connected to a ventilator or manual ventilation is provided using a bag-valve-mask.
Duration
The procedure typically takes 5-10 minutes, although preparation and assessment might take longer in complicated cases.
Setting
Endotracheal intubation is usually performed in a hospital setting, such as the emergency room, intensive care unit (ICU), or during emergency transport.
Personnel
- Emergency physicians
- Anesthesiologists
- Critical care specialists
- Paramedics
- Nurses
Risks and Complications
- Damage to teeth or soft tissues in the mouth and throat
- Aspiration of stomach contents
- Misplacement of the tube (e.g., esophageal intubation)
- Hypoxia (low oxygen levels)
- Infection
- Vocal cord injury
- Pneumothorax (collapsed lung)
Benefits
- Immediate and reliable airway management
- Ensures adequate oxygenation and ventilation
- Stabilizes patient condition, providing time for further medical intervention
Recovery
- Careful monitoring in a critical care setting
- Management of any injuries or complications that arose from the procedure
- Gradual weaning from the ventilator once the patient can breathe on their own
Alternatives
- Non-invasive ventilation methods (e.g., continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP))
- Use of airway adjuncts like oropharyngeal or nasopharyngeal airways
- Emergency cricothyrotomy or tracheostomy in severe cases
Patient Experience
- Typically, the patient is unconscious or sedated; therefore, they are unlikely to feel or remember the procedure.
- Post-procedure discomfort in the throat and voice hoarseness may occur.
- Pain management and sedation to ensure patient comfort during recovery.