Intubation tips?

[CALEMT]

Not gonna lie, I'm glad I found this thread considering I'm starting my clinical rotations soon.

 

[E tank]

I'll weigh in on laryngeal manipulation, BURP and cricoid pressue. Cricoid pressure in an adult has never been shown to actually prevent aspiration during rapid sequence induction/intubation. It just makes intubation more difficult. I don't use it. That said, applying pressure at the thyroid or even hyoid levels does appreciably improve direct laryngoscopy in the more "anterior" airway.

Laryngeal manipulation with the right hand while scoping with the left has been something that has been done intuitively in the OR for generations. It's just been given a name recently. The thing is, the laryngocopist needs the right hand for intubation so you need another person to hold the manipulation for a good view. Most often, it ends up being a BURP to one degree or another.

Cricoid pressure in the pediatric patient, however, is very useful during DL

 

[TomB]

Hello, I'm doing my field internship right now, and I'm horrible with intubations. I've had about five intubation attempts and two king airways, and I failed all of my intubations. My first three attempts where in a moving rig, and my next two were were during cpr. It's definitely more difficult than doing it on a mannequin. Are there any tips you guys can throw out there? How much pressure do you have to apply while lifting up the tongue? There were some cases on which I was able to visualize the vocal cords, but can never get my tube in.

How I wish I had access to this information when I was in Paramedic school. Good luck!

How To Master Tracheal Intubation

Airway Management With Rich Levitan

 

[VentMonkey]

Has anyone practiced this technique at their service? If so, what do/ did you all think?

P.S.- thanks, @NomadicMedic.

 

[Carlos Danger]

I think the only "trick" I can pass on is that if I'm having any trouble DL'ing, especially if positioning is less than optimal, I'll put my right hand under the occiput and pick the head up while I continue to DL with my left hand. Then I'll reach around and manipulate the larynx until I get it where I want it.

Don't remember ever being shown that or seeing anyone else do it, it just seems intuitive to me. The rest of it is just all the basic technique that has been mentioned.

Also, how do people feel about using a Mac blade but overshooting past and lifting the glottis with it? I've unintentionally done this on the airway mannequin and it also happened on a cadaver with a really anterior airway. Visualization is visualization? Or are we concerned about trauma to the glottis (though keeping in mind a Miller is intended to be used this way)?

Regardless of whether you are using a curved or straight blade, if you just happen to go past the epiglottis and then find it as you back out a little bit, it's perfectly fine. ButI think intentionally burying the blade is not the best technique. As a beginner, you want to get to know the anatomy and progressing slowly under the tongue while looking at landmarks is probably the best way to do it.

 

[dutemplar]

Position the Pt for your best view based on anatomy. Oxygenate as best you can. Don't panic.