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.