Here are my top 8 tips for succeeding at intubation.
1. Use a Video Laryngoscope(VL), or at least have one nearby
Okay, maybe a little controversial still. But if there is some way that you can get your hands on one, have it on standby. In a statement several years ago, Ron Walls said that VL was the standard of care and we should be using it. There was an outcry! People were concerned: “We need to know how to use a normal laryngoscope, what if the video laryngoscope doesn’t work, or I go to an ED without one?”
I understand, I hear you. But……..if you can use a normal laryngoscope, why not use a VL such as a C-MAC( I have no financial interest to declare) or similar, where the blade is the same and you can use it as a normal laryngoscope or kick it into gear and get the help you need.
Personally I always feel better when I know I have one there. How often might I need to use it? Less than 5% of the time.
2. Time: Make sure I have the maximum amount of apnoea time available to me
I am and have always been a massive fan of apnoeic oxygenation. I do whatever I can to maximise oxygen reserves in my patients. I use the nasal prongs at high flow, I use CPAP before intubation, I use sitting up and delayed sequence intubation…..whatever I can to buy me time.
3. Position: Tragus of the ear to Sternal Notch
We’ve covered this so many times, but it’s important to do so once again. The aim is to lift the head so that the ear and the sternal notch are in line. This brings the cords into view. Obviously not in the suspected cervical injury. That’s where VL comes into use.
4. Sweep the blade to the left and hold in the midline
When inserting the laryngoscope blade, do so to your right(ie., the right side of the patient’s mouth) and sweep the tongue towards the left, BUT let the blade come to rest in the midline. Why? Because you want to give yourself maximum room to the right of the patient’s mouth to be able to see where you are inserting the tube giving you the best view of the anatomy(the midline view). If it helps get a friend to pull the patient’s right cheek back, so you can get a better view.
5. Perform Epiglotoscopy
The most important landmark when looking for the cords are not the cords, but the epiglottis. Find the epiglottis and you will find the cords. The best way to do this is to find the back of the tongue and then move slowly downwards. The single biggest mistake I see, is that the blade is introduced in too far to begin with. It’s past the epiglottis. If this happens, just pull the blade back and the epiglottis will flop into view.
6. Don’t pivot the blade unless you want to break the teeth
In patients with dentures, we leave those dentures in whilst bagging, as they scaffold the mouth, so we can ventilate. When it’s time to intubate we remove them. In patients who have their own teeth, one of the risks we run is to break those teeth. Do that and you’re in a world of hurt, as you now have broken teeth that need repair, but you may also have fragments that will need to be retrieved via bronchoscopy at some point. The technique is not swivelling or pivoting the laryngoscope, but pulling out in the direction of the handle.
7. Always use a stylet
I always use a stylet. There is the argument of bougie vs stylet. My argument is that the angle at the end of the stylet and the bougie is the same. If there is any swelling of the airway, the stylet may be better. Also if it is a very anterior airway, the angle of the stylet can be manipulated to what you need.
Irrespective of which you use. Use one.
8. Only rely on End Tidal CO2(ETCO2) for verification of tube placement
“I saw it go through the cords” may be famous last words. I’ve said them myself. I saw the tube go through, but the sats are dropping and there is no ETCO2 trace………the tube’s not in. Pull it out and do it again.
Misting of the tube is unreliable. Auscultating for breath sounds is misleading, as a tube in the oesophagus may generate sounds that appear to be coming from the lungs.
ETCO2 is the gold standard. Wait for several waveforms. Read the Blog on Capnography.
67 Comments
Leave a Comment
Popular Posts
Paediatric Pearls
Treating the Hypoxic COVID-19 Patient: Can low flow systems be improved?
Cardiogenic Shock: Which Vasopressor to use
The U wave and the ECG: Don’t miss this
5 Things you Must do when Patients Present with Syncope
11 Things to Maximise Adult Cardiac Resuscitation
Amiodarone vs Procainamide for Ventricular Tachycardia
My top 8 tips for getting the tube. – Resus
refkldjj http://www.g796ut343g3x987t41dbtiylyk6f8z02s.org/
arefkldjj
[url=http://www.g796ut343g3x987t41dbtiylyk6f8z02s.org/]urefkldjj[/url]
I like what you guys are up too. Such smart work and
reporting! Carry on the superb works guys
I have incorporated you guys to my blogroll.
I think it’ll improve the value of my website :).
Feel free to visit my web page – freshly hatched seeds
Hi! I could have sworn I’ve been to this website before but after checking through some of the
post I realized it’s new to me. Anyways, I’m definitely
happy I found it and I’ll be bookmarking and checking back often!
Also visit my blog post; recommendations for an omega 3 diet
Very shortly this web page will be famous amid
all blogging and site-building viewers, due to it’s pleasant posts
Here is my web-site – shaving pubic hair
I adore looking at and I believe this website got some genuinely utilitarian stuff on it!
my site – weed doctor
I am impressed with this web site, rattling I am a big fan.
Check out my page better sex life
Please let me know if you’re looking for a author for your weblog.
You have some really good articles and I think I would be a good asset.
If you ever want to take some of the load off, I’d love to write some material for
your blog in exchange for a link back to mine. Please shoot me an email if interested.
Regards!
Look into my page – first time sex tips – http://www.fles.hlc.edu.tw –
Good web site you have got here.. It?s difficult to find
high-quality writing like yours nowadays. I honestly appreciate people like you!
Take care!!
Also visit my web page … growing weed indoorshave
My family members all the time say that I am
killing my time here at web, however I know I am getting know-how all the time by reading such
nice posts.
my page; testosterone production
You got a very fantastic website, Gladiolus I observed it through yahoo.
Also visit my website: hemp seed
We still cannot quite think that I could end up being one of those studying the important
points found on your site. My family and I are
really thankful for the generosity and for offering me the opportunity to pursue
this chosen career path. Appreciate your sharing the important information I managed to get from your
website.
Also visit my blog :: omega 3 – http://www.mhes.tyc.edu.tw –
Aw, this was a very nice post. Finding the time and actual effort to make a superb article?
but what can I say? I put things off a lot and don’t manage to get anything done.
Here is my blog – treat yeast infection
You’re so cool! I don’t believe I have read through anything like that before.
So wonderful to discover someone with some unique thoughts
on this subject. Seriously.. thanks recommendations for an omega 3 diet,
http://www.mhes.tyc.edu.tw, starting this
up. This website is one thing that is required on the web, someone
with a little originality!
Wow, superb weblog format! How lengthy have you ever been blogging for?
you make running a blog look easy. The total
look of your web site is fantastic, let alone the content material![X-N-E-W-L-I-N-S-P-I-N-X]I just couldn’t
go away your website before suggesting that I extremely enjoyed the standard info an individual provide for
your guests? Is gonna be again incessantly in order to inspect new posts.
Here is my homepage: houston affordable treatment
I’m impressed, I must say. Rarely do I come across a blog that’s both equally
educative and interesting, and without a doubt, you have hit
the nail on the head. The issue is something which not enough folks are speaking intelligently about.
I’m very happy that I came across this during my hunt for something relating to this.
Check out my page – fish oil
Hello! I could have sworn I’ve been to this web site before but
after going through some of the posts I realized it’s new to me.
Nonetheless, I’m certainly happy I stumbled upon it and I’ll be bookmarking it and checking back often!
Have a look at my webpage skilled drug crime (http://23.95.102.216/)
Thank you, I have recently been searching for info approximately this topic for
ages and yours is the best I’ve came upon till now.
But, what about the conclusion? Are you certain concerning the source?
my web page: diets that work
I must thank you for the efforts you’ve put in penning this blog.
I am hoping to view the same high-grade blog posts from you later on as well.
In truth, your creative writing abilities has inspired me
to get my own, personal site now 😉
Here is my website – mashed potato diet
Would love to constantly get updated outstanding web site!
Feel free to surf to my page :: care tips honey
Thanks for another excellent article. Where else may anybody get that
type of information in such a perfect method of writing?
I have a presentation next week, and I am at the search for such information.
My web blog … cannabis seeds starts
Great blog! Is your theme custom made or did you download it from somewhere?
A theme like yours with a few simple adjustements would really make my blog jump out.
Please let me know where you got your theme. Bless you
my web site – natural skin
Good write-up, I’m regular visitor of one’s
site, maintain up the excellent operate, and It is going to be a regular visitor for a lengthy time.
Feel free to visit my blog fat burners [mhes.tyc.edu.tw]
It’s hard to find experienced people on this
subject, but you sound like you know what you’re talking about!
Thanks
Also visit my web page; various low-carb diets
I just wanted to type eating healthy on a budget (Randall) quick remark so as to thank you for all the awesome tricks
you are placing here. My rather long internet lookup has at the end been compensated with reliable points to share with my partners.
I would assume that we visitors actually are unquestionably fortunate to be in a wonderful website with
very many marvellous professionals with very beneficial principles.
I feel truly privileged to have seen your webpages and
look forward to some more excellent moments reading here.
Thanks again for everything.
I have fun with, result in I discovered just what I was having
a look for. You’ve ended my four day long hunt! God Bless you man. Have a great day.
Bye
For hottest information you have to visit world-wide-web and on internet I found this web site as
a most excellent web site for most recent updates.
Here is my blog: weight loss plan (forum.m2clasic.ro)
Hello there! Do you know if they make any plugins to safeguard against hackers?
I’m kinda paranoid about losing everything I’ve worked hard on. Any suggestions?
Also visit my blog post; burn fat
Excellent blog here! Also your site loads up very fast!
What web host are you using? Can I get your
affiliate link to your host? I wish my web site loaded up as quickly as
yours lol
Wow! Thank you! I continuously wanted to write on my blog something like that.
Can I take a fragment of your post to my website?
Also visit my web site – forum.m2clasic.ro
What i do not understood is if truth be told how you’re now not really a lot more smartly-appreciated than you might be right now.
You’re so intelligent. You understand therefore significantly libido enhancement in men terms of this matter,
produced me in my opinion believe it from a lot of various angles.
Its like women and men are not involved except it is one thing to do with
Woman gaga! Your own stuffs nice. At all times handle it up!
I really appreciate this post. I’ve been looking all over for this!
Thank goodness I found it on Bing. You’ve made my day! Thank you again!
Also visit my page – growing weed indoors
Please let me know if you’re looking for a writer for your site.
You have some really good articles and I feel I would be a good asset.
If you ever want to take some of the load off, I’d absolutely love to write some material for your blog in exchange for a link back
to mine. Please shoot me an e-mail if interested.
Many thanks!
Feel free to surf to my blog post: prettypeople.club
This piece of writing is in fact a pleasant one it helps new the web viewers,
who are wishing in favor of blogging.
you are in point of fact a good webmaster.
The web site loading pace is amazing. It seems that you’re doing any unique trick.
Furthermore, The contents are masterpiece. you have done a magnificent process in this subject!
Hey there! This is my first visit how to stop smoking weed
your blog! We are a collection of volunteers and starting a new project in a community in the same niche.
Your blog provided us valuable information to work on. You have
done a marvellous job!
For latest information you have to visit web and on world-wide-web I found
this site as a most excellent web site for most up-to-date updates.
Also visit my homepage … eating healthy
What’s up, its fastidious piece of writing concerning
media print, we all know media is a impressive source of information.
Also visit my site; http://www.aniene.net
Wow, this post is good, my sister is analyzing these kinds of
things, therefore I am going to convey her.
Hi there just wanted to give you a quick heads up.
The words in your post seem to be running off the screen in Internet explorer.
I’m not sure if this is a formatting issue or something to do with browser
compatibility but I figured I’d post to let you know.
The layout look great though! Hope you get the problem resolved
soon. Kudos
Howdy! Quick question that’s entirely off topic. Do you know how to
make your site mobile friendly? My website looks weird
when browsing from my iphone 4. I’m trying to find a template
or plugin that might be able to resolve this problem.
If you have any suggestions, please share. Thanks!
This design is steller! You obviously know how to keep a reader entertained.
Between your wit and your videos, I was almost moved to start my own blog (well, almost…HaHa!) Fantastic
job. I really enjoyed what you had to say, and more than that,
how you presented it. Too cool!
Also visit my blog :: high carb
Hi, I check your blogs daily. Your writing style
is witty, keep up the good work!
I could not resist commenting. Exceptionally well written!
I am genuinely happy to read this webpage posts which carries lots of valuable data, thanks for providing such statistics.
Howdy would you mind stating which blog platform you’re working with?
I’m looking to start my own blog soon but I’m having a difficult time deciding between BlogEngine/Wordpress/B2evolution and Drupal.
The reason I ask is because your design and style
seems different then most blogs and I’m looking for something
completely unique. P.S My apologies for being off-topic but I had to ask!
Good post! We are linking to this great content on our website.
Keep up the great writing.
Hello, i think that i noticed you visited my site thus
i got here to go back the want?.I’m attempting to find
things to enhance my site!I assume its ok to make use of some of your ideas!!
Pretty part of content. I simply stumbled upon your blog and in accession capital to claim that
I get actually enjoyed account your blog posts. Anyway I’ll be subscribing on your
augment and even I achievement you access constantly quickly.
My website; free indoor growing
I’ve recently started a web site, the info you offer on this web
site has helped me greatly. Thanks for all of your time & work.
Feel free to surf to my blog post … a913.vip
Thanks so much for providing individuals with remarkably wonderful opportunity
to read in detail from here. It can be very sweet and full of a lot of fun for me and my office colleagues to search the blog no less than thrice in a week
to study the latest guidance you will have. Not to mention, I am just at all times pleased with all the good
hints served by you. Some 4 ideas in this post are easily the simplest we have ever had.
Feel free to surf to my web site: gain weight
Woh I love your blog posts, saved to my bookmarks!
My web blog :: seed sprouts
Thanks for sharing your thoughts on cannabis dispensaries-san. Regards
My page; affordable treatment
Hi, every time i used to check website posts here early in the morning,
for the reason that i love to learn more and
more.
My web blog :: foroagua.com
My developer is trying to persuade me to move to .net
from PHP. I have always disliked the idea because of the expenses.
But he’s tryiong none the less. I’ve been using WordPress on numerous websites for about a year and am anxious about switching to another platform.
I have heard very good things about blogengine.net.
Is there a way I can import all my wordpress content into it?
Any kind of help would be greatly appreciated!
my web site … diet lacking
Hi there! Do you know if they make any plugins to help with Search
Engine Optimization? I’m trying to get my blog to rank for some
targeted keywords but I’m not seeing very good success.
If you know of any please share. Many thanks!
my web-site … drug rehab centres
Fire Flasher And Sounder
ブランドPradaプラダ靴コピーN級品
Aluminum Folding Table
ブランドLouisVuittonルイヴィトンベルトコピーN級品
コピー時計
Crawler Shot Blasting Equipment
China Seamless Steel Pipe
ブランドバッグコピー
Sunglasses For Women Trendy
ブランドコピー専門店
ブランドコピー専門店
Stamping Metal Parts
P1000 Pipette Tips
ブランドバッグコピー
スーパーコピーブランド
24 Awg Ul 1007
At this time I am going to do my breakfast, afterward having
my breakfast coming again to read further news.
Door Cold Press Machine
Sterile Disposable Shake Flasks
ブランドコピー専門店
ブランド財布コピー
Gmc Brake Disc Rotor
Powder with Zinc Oxide 1314-13-2
スーパーコピーブランド
Battery Impedance Tester
Cl Nonwoven Machinery