# Alternative Intubation Method



## Hastings (Jun 28, 2008)

Ok, quick, strange question. Anyone out there default to a front approach to intubation as opposed to the standard method? As in, instead of positioning oneself behind the patient and pulling up with the blade, positioning oneself in front of the patient and pulling down/forward. I initially learned intubation the usual way, but got in the habit of doing it this other way because it's easier. Are there any complications of doing so, or is it an acceptable way to intubate regularly?


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## KEVD18 (Jun 28, 2008)

i havent the foggiest clue as to what you are reffering to.


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## Ridryder911 (Jun 28, 2008)

It's called the "tomahawk" or "Aussie" position. Something that has been taught for decades in PHTLS. It is a great maneuver when space is limited or very anterior or potential C-spine injuries. 

R/r 911


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## MSDeltaFlt (Jun 28, 2008)

Knew a flight nurse who only used that method.  Never used it myself... yet.


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## Hastings (Jun 28, 2008)

Ridryder911 said:


> It's called the "tomahawk" or "Aussie" position. Something that has been taught for decades in PHTLS. It is a great maneuver when space is limited or very anterior or potential C-spine injuries.
> 
> R/r 911



I only use that method too. My only question is whether there is any additional risk involved with this method as opposed to the traditional method. I have yet to encounter any problems, but I always receive strange looks from fellow medics when intubating in this manner.


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## Flight-LP (Jun 28, 2008)

I wouldn't forsee any additional risks, but considering the preparatory steps of intubation call for aligning the axis' for direct, the view may be slightly skewed. I have only used it as previously described, in confined spaces.................


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## fma08 (Jun 28, 2008)

haven't used it yet... but like others were saying, confined spaces is where i'd use it like in a car or such


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## WuLabsWuTecH (Jun 29, 2008)

We were taught it in our EMT class.  Its for use when you're in a car and you have limited space above and behind.  We were taught how to do it blind though and no laryngoscope, only fingers and a tube with a stylette.  Its really hard to do and I don't foresee ever having to do it, but good to know if you're ever in that situation.

Speaking of which, does anyone else do it w/o a laryngoscope in this case?


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## fma08 (Jun 29, 2008)

what you're describing i believe is called digital intubation, which is an alternative method where you use the fingers instead of the scope, but i'll let the veterans go into more detail here


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## Hastings (Jun 29, 2008)

Yeah, you should never have to do a digital intubation. And you shouldn't.

The last and only time I did it, I was wearing two layers of glove and the friction/scraping against the teeth tore through both layers and cut my first two fingers. You should always have a scope available. And if you don't, in my opinion, wait to intubate.


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## Ridryder911 (Jun 29, 2008)

Hastings said:


> Yeah, you should never have to do a digital intubation. And you shouldn't.
> 
> The last and only time I did it, I was wearing two layers of glove and the friction/scraping against the teeth tore through both layers and cut my first two fingers. You should always have a scope available. And if you don't, in my opinion, wait to intubate.



Sorry, but bologna. get thicker gloves and your fingers should not be against the upper incisors. They should be pushing caudally. Alike you described in the tomahawk position. Digital intubation is a wonderful and unique intubation that has been out since the time intubation was first invented. This is how Veterinarians intubate. I wrote an article on Difficult Intubations for JEMS about 17 years ago referencing this procedure. 

I use it all the time on those that you cannot suction enough and those with severe facial/trauma/ blood such as La Forte fractures. 

Alike adjuncts that can aid and assist in difficult intubations. For example "trigger tubes" , flex guide, "airtraq" are common intubation usages as well. Trigger tubes have a built in styllette that has an attached ring to the distal end of the  ET tube is able to bend. Flex guide or elastic bougie, allows you to intubate with a semi rigid device and then slide the ET over the device. The Airtraq is wonderful device that I love to use on severe trauma patients as well. It is a disposable fiber optic laryngoscope that you look through, and visualize. It has a heating element to eliminate "fogging". 

Folks, all of this should had been taught and covered in your generalized Paramedic course, or any ITLS/PHTLS courses. These intubation techniques are NOT new.

R/r 911 

Here is a link for videos on the "airtraq" there are several video's. The costs is about $100 each.

http://vam.anest.ufl.edu/airwaydevice/videolibrary/airtraq3p15.html#sim


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## Alexakat (Jun 29, 2008)

I took PHTLS last year & the gal teaching it called it "face-to-face" intubation.


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## mycrofft (Jun 29, 2008)

*Training, practice and memory*

We lose what we don't practice, we forget what we don't practice, we don't practice what we don't like or learn for whatever reason. Some skills it is tricky/risky to learn if folks will not use them and get decent performance feedback, because at some point they are going to try it (either in a flush of rookie exuberance or as a "Hail Mary") and blow it, perhaps delaying transport to higher levels of care, or another more accomplished practitioner to coe in and do it.


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## mikeylikesit (Jun 29, 2008)

we call it Aussie from here and i use it all the time, and until i hear from an RRT or higher i will continue to use it. i have used digital intubation because my dad had me practice it. i like the idea of digital but i am always afraid of getting my fingers gnawed on.


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## el Murpharino (Jun 29, 2008)

I learned the Tomahawk when I took an airway class a few months ago - we had a scenario set up where our "patient" was upside down strapped to a table to mimic the rollover victim still strapped in a car.  I've never heard it called the Aussie style....but I'm pretty out of the loop on things.  True it's one of those 'one-in-a-million' instances, but you got to train like it's the real world.


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