ESSENTIAL STEPS IN THE INTUBATION OF THE TRAUMA PATIENT
The following is an overview of those steps considered essential in the intubation of a trauma
victim where the cervical spine has not been cleared.
Preparation:
Pre-oxygenation with 100% oxygen
Suction available and operating
Two functioning laryngoscopes
ETT checked and introducer available
Drugs drawn up and ready to be administered
Monitoring equipment ( including pulse oximeter / end tidal CO2 monitor )
Equipment for surgical airway available
If time permits and xray facilities available, a lateral cervical spine xray should be
obtained prior to intubation. A normal lateral cevical spine xray is reassuring.
However, a normal lateral cervical spine view does not rule out a cervical spine injury.
In-line manual cervical immobilization ( not traction )
Cervical collar undone and opened anteriorly (alternatively can be removed
completely during intubation and then reapplied once airway is secure )
Performed by assistant who places hands on either side of the head from above,
gently immobilizing the patient’s head and neck in a vertical position.
Cricoid pressure application
Cricoid pressure ( or the Sellick manoeuvre ). This simple procedure involves the
digital application of 15-20 mmHg of pressure over the cricoid cartilage using the
thumb and index finger.
Cricoid pressure is maintained until the endotracheal tube is passed, cuff is inflated,
ETCO2 monitor displays adequate trace and chest is auscultated.
Endotracheal tube is secured.
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