EMTB9e: Interactive Ready for Review for Chapter 39

· tubes provide a channel directly into a patient's stomach, allowing you to remove gas, blood, and toxins or to administer medications and nutrition. In the field, gastric tubes are most commonly used to decompress the stomach of a patient with gastric distention.
· There are two types of gastric tubes: nasogastric tubes and orogastric tubes. An orogastric tube, which is inserted through the mouth, is safer and easier to use. A nasogastric tube, which is inserted through the nose, can cause nasal trauma with bleeding and, in patients with a skull fracture, can be accidentally passed into the brain. Either type of tube can be accidentally passed into the
.
· Insertion of a gastric tube is a delicate task that must be done strictly according to local EMS protocol, with special care being taken for a patient who has head, spinal, or major facial trauma.
· , the insertion of a tube into the trachea to maintain and protect a patient's airway, can be done through the mouth (orotracheal intubation) or through the nose (nasotracheal intubation).
· intubation can be performed only in patients who are breathing; it should not be performed in patients with a possible skull fracture. intubation is needed for patients who are unconscious, unresponsive, or in cardiac arrest.
· intubation controls and protects the airway and may be used long-term if necessary. It also permits direct access to the trachea for suctioning, the delivery of high volumes of oxygen at higher than normal pressures, and the administration of certain medications.
· There are two techniques for insertion of an endotracheal tube: using a and using a lighted stylet.
· Some of the equipment needed for endotracheal intubation includes the correctly sized ET tube; a laryngoscope or lighted stylet, stylet, and syringe; oxygen with a BVM device; a suctioning unit; and Magill forceps (if a laryngoscope is used).
· Complications of endotracheal intubation include intubation of the right mainstem bronchus or the esophagus, aggravation of a spinal injury, increased hypoxia because of taking too long to intubate, causing soft-tissue trauma, mechanical failure, and a decrease in heart rate. A patient who regains consciousness may also vomit and/or try to remove the tube.
· A patient who has been intubated must be monitored continuously to evaluate the heart rate (especially in children) and lung sounds. In addition, movement of the patient can dislodge the ET tube. Always reassess after any patient movement.
Multilumen airways, such as the Esophageal Tracheal Combitube and the pharyngeotracheal lumen airway, and the laryngeal mask airway are inserted blindly and are easier to insert than an ET tube. However, you must be trained and authorized to use these devices.