Intubation Confirmation

Related Procedures

Procedures related to intubation confirmation in the EMS setting:

1. Stroke recognition: Cincinnati Prehospital Stroke Scale (facial droop, arm drift, speech) then last known well time then transport to stroke center
2. Pediatric weight-based dosing: Broselow tape for length-based weight estimation in emergencies
3. RSI sequence: preoxygenation then sedation (etomidate 0.3mg/kg or ketamine 2mg/kg) then paralytic (succinylcholine 1.5mg/kg or rocuronium 1mg/kg) then intubation then confirm placement with waveform capnography

Step-by-Step Procedure

Protocol steps for intubation confirmation:

STEMI protocol: 12-lead ECG within 10 min then aspirin 324mg then NTG if SBP >90 then notify cath lab then transport code 3

Overview

ETT verification: waveform capnography (gold standard), clinical assessment, tube visualization. Confirmation methods tested on Paramedic exam.

In prehospital assessment, blood glucose reference range: adult 70-140 mg/dL, pediatric 60-100 mg/dL (neonates lower). Deviations from these norms guide treatment decisions in the field.

Troubleshooting

Troubleshooting intubation confirmation in the field:

• Pulse oximeter: If measures spo2 via infrared absorption through capillary bed fails, verify connections, check battery, try alternate equipment. Available sizes: Finger clip, Earlobe, Pediatric wrap
• Waveform capnograph: If measures end-tidal co2 continuously with waveform display fails, verify connections, check battery, try alternate equipment. Available sizes: Mainstream (inline), Sidestream (sampling)
• BVM: If bag-valve-mask for manual ventilation fails, verify connections, check battery, try alternate equipment. Available sizes: Adult (1500mL), Pediatric (500mL), Infant (250mL)

Documentation

Documentation of intubation confirmation in the patient care report (PCR) must include: time of assessment, findings, interventions performed, patient response, and reassessment findings. Use objective, measurable terms like "patient reports 8/10 chest pain" rather than "patient in pain." Document pertinent negatives. All medications administered must include drug name, dose, route, time, and patient response.