When you think of intubation, you should automatically be thinking "suction." The two treatments go hand in hand; you cannot safely intubate without the aid of suction, which is why you must include the portable suction unit anytime there is the possibility of intubating.
Suction plays several important roles in securing an advanced airway. They include:
Include the portable emergency suction unit in your ALS assemblage or stow a suction unit in your airway bag so that it is always available.
Deciding when a patient needs an advanced airway is a crucial step in treatment. The key is to differentiate between a patient in respiratory distress and a patient in failure.
Respiratory distress is characterized by:
A patient in respiratory failure needs immediate intervention, preferably with an advanced airway. He or she will exhibit the following signs:
Once you decide that intubation is needed, the next step is to assemble your equipment. Have someone maintain airway patency while this important step is accomplished. Have suction at the ready, to keep the airway clear. Your intubation equipment will include:
COVID-19 requires some extra precautions. Be sure to wear a fit-tested N95 respirator, face protector such as a shield, gown, and gloves. Plan what you will be doing carefully, and do it as quickly as possible.
Once you have the endotracheal tube in place, your patient may still require suction. If the patient has chest or airway trauma, or a history of COPD, he or she may have bloody froth enter the tube from the lungs. In such situations, it may be necessary to suction the tube.
The main tool you'll need is your portable suction unit, which should already be in place during intubation. Next, you will need to:
As with any airway procedure, you may experience complications. Be alert for the following:
Be sure to keep the portable suction unit nearby should the tube become dislodged or the patient vomits. Even with an endotracheal tube in place, the patient may still vomit, necessitating rapid suction.
Your best practices for both suction and intubation are to think of them as inseparable: Never attempt intubation without the portable suction unit and always have suction at the ready during any respiratory emergency.
Editor's Note: This blog was originally posted on Nov 2017 and has recently been updated with new content.
2011, Pollak, A., Ed.
Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.