Airway Management: The Basics Of Endotracheal Intubation

Airway management (AM) can be life-saving in certain emergency situations. Physician assistants may encounter patients requiring AM in virtually any clinical setting. Endotracheal intubation (EI) is indicated in several clinical situations including respiratory failure, cardiorespiratory arrest, upper airway obstruction, in patients at risk for aspiration, and for certain elective procedures. It is mandatory that a clinician responsible for airway management be familiar with airway anatomy and how it pertains to intubation. Ideally, prior to attempting EI, all necessary equipment, medications, emergency supplies, and support staff should be in place. Patients should be monitored before, during and after intubation. Proper technique of EI is reviewed, as well as assessment of proper endotracheal tube placement. INTRODUCTION Physician assistants (PAs) can encounter patients that require airway management (AM) in virtually any clinical setting. All PAs should therefore be familiar with the basics of these potentially life-saving procedures. This article is meant to serve as a general introduction to one of the techniques of AM, endotracheal intubation (EI) of the adult patient. PAs who work in environments where patients are likely to need AM should obtain training and experience in the proper technique of EI, medications used for the procedure, as well as alternative methods of AM when EI is unsuccessful (see Table 1). A subsequent article in this series will review alternative techniques in AM, including those useful for the less experienced clinician in emergency situations. TABLE 1: Alternative techniques to establish an airway