Learning Intubation: A Beginners Guide

To learn intubation in addition to learning the physical steps, you need to understand why you’re doing those steps. This article will explain how to perform the steps of intubation, as well as the rationale behind them. Links to other articles on intubation technique appear both in the body of the text as well as repeated as a list at the end. Read More …

First Pass Intubation: When You Can’t See The Cords

Failure to see the cords on first pass intubation occurs about 10% of the time. This article describes the thought process behind the next steps for approaching the next intubation attempts. Read More …

The MAC Blade, The Vallecula, and the Hyoepiglottic Ligament

Intubation with the MAC blade requires precise placement of the tip of the blade in the vallecula in order to manipulate the hyoepiglottic ligament and lift the epiglottis. This discussion uses illustration, Xray, and video to demonstrate proper intubation technique. Read More …

Learning Intubation: Head Position Effects Laryngeal View

When first learning intubation,  a beginner often concentrates on memorizing the key laryngeal anatomy. This is important of course. If you can’t recognize the vocal cords, you will not be able to successfully intubate. However, even more important to learning intubation is understanding how the larynx relates to the other structures in the head and neck. In order to intubate you must manipulate those other structures to bring the larynx into view. This post uses lateral X-rays and CT scan images to help novice intubators master the anatomical relationships they must know to intubate. Read More …

GlideScope Technique For Intubation In Small Mouths

The GlideScope can be difficult to use in a patient with a small, narrow mouth. This article discusses a technique for improving successful intubation in that type of patient. Read More …

When Learning Intubation Is Hard

Learning to intubate is easier for some people than for others. Sometimes, no matter how knowledgeable you are about the theory of the technique, the novice can still struggle to bring it all together to pass the endotracheal tube. The anatomy can be confusing. Understanding how to place the laryngoscope blade and manipulate that anatomy can be challenging. And all the while you must be ever vigilant to protect those precious front teeth, avoid hypertension and tachycardia, and breathe for the patient at regular intervals. This article discusses 4 chief technical barrier to learning to intubate. Read More …

Intubation With A Curved Blade

Direct laryngoscopy depends on being able to bring the 3 axes of the airway into alignment to see the larynx. Straight and curved blades use different techniques for bringing the larynx into view. Curved blades are commonly used, especially by beginners because they are more forgiving of less than optimal placement and provide more room to pass the tube. However, it’s important to use them correctly. This article will discuss intubation technique using a curved blade. Read More …

Intubation: Step By Step

Fall is the time of year when new students commonly begin to learn how to intubate. My first intubation was one of the first times I literally held someone’s life in my hands. I was nervous. The anesthesiologist teaching me tried to not look too anxious as I awkwardly grabbed my laryngoscope blade, fumbled while opening the patient’s mouth, and cautiously maneuvered the endotracheal tube into the trachea. It felt like time stopped until the tube was in place, after which the three of us (me, my teacher and my patient) all took a deep breath. Since then, over the last almost 37 years, I’ve intubated thousands of people in the U.S. and, as an international volunteer, eight countries.

So I thought it would be helpful at this time of year to discuss a step-by-step approach to intubation with the commonly used curved blade. Intubation, like a dance, is composed to steps that flow naturally from one to the next. The trick to a smooth intubation is to allow each step to blend seamlessly together. The description and illustrations below are excerpted from my book Anyone Can Intubate, where you can find more detail about this and many other topics. Read More …

Tips To Teaching Intubation

With fall comes the new crop of trainees eager to learn how to intubate. There will also be a new group of instructors teaching their first students to intubate. Teaching intubation skills on living patients, even those that have practiced on a manikin, can be challenging. It’s important to anticipate the common errors so we can safeguard our patients. Read More …

Anticipated Difficult Intubation: Should I Intubate The Patient Awake?

When facing any intubation, you must decide whether the intubation is safer to be performed asleep or awake. Many providers are uncomfortable with performing awake intubations and leave it as a last resort. There are a variety of reasons for this discomfort, including lack of experience and/or the fear that the patient will remember the intubation and think poorly of their care. However, awake intubation can be a safe and comfortable strategy in many clinical situations. This article discusses some of the criteria for deciding when to do an awake intubation. Read More …

Avoiding Difficult Intubation Of The Easy Airway

We’ve all done it. It’s extremely easy to make any otherwise routine intubation difficult just by failing to properly position the patient or to use optimal technique. This article discusses the various ways you can adjust patient positioning and use your equipment to make intubation easy. Read More …

Positioning The Head For Intubation

This article discusses the different ways of placing the patient in the sniffing position and the advantages and disadvantages of each to improve first pass intubation success. Position of the head and neck for intubation can make intubation easy, or hard.
Many years ago our operating room administration Removed the towels we had been using to position the head for intubation. It may be an exaggeration to say that chaos ensued, but it felt like that.

For the next several days our anesthesia providers had trouble intubating. We likened it to an expert golfer who, when suddenly faced with a new set of golf clubs of slightly different weight and length, suddenly has to relearn the game. It made us realize that how we position the head in the sniffing position often sets us up for either an easy or for a more difficult intubation if you don’t realize what’s happening during the positioning. Read More …

To Extubate, Or Not to Extubate, That Is The Question

Deciding when to extubate a patient safely can sometimes be a difficult decision. Removal of an endotracheal tube when you are not sure of the diagnosis is a risk not to be taken lightly. This case discusses assessing extubation criteria in the face of ambiguous respiratory symptoms. Read More …