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 …

# 1 Review Article for Anesthesiology News 2018: 10 Rules for Approaching Difficult Intubation by Christine Whitten

And the numbers are in, my review article for Anesthesiology News was actually THE MOST viewed article on the site for the whole year! The link for the article is included. Please feel free to share.
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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 …

Difficult Intubation In A Newborn

The unanticipated difficult neonatal intubation in L&D greatly complicates neonatal resuscitation. This discussion highlights the approach to difficult ventilation & intubation in the newborn. #FOAMED Read More …

Intubation During Cardiac Resuscitation

Intubating patients during cardiac resuscitation is often challenging because of the circumstances surrounding the intubation. Excitement and apprehension accompany this life saving effort. In addition, The patient is often in a less than optimal position while chest compressions are in progress. You usually find the patient in one of two awkward positions: on the ground or in a bed. This article discusses techniques to better manage intubation during cardiac resuscitation, especially with the patient in an awkward position. 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 …

Airway Emergency: Start With The Basics of Airway Management

A case of “can’t intubate- can’t ventilate is discussed which illustrates the importance of always using good techniques of basic airway management. Read More …

Hair Style Can Impact Intubation

Last weekend I spent time with the charity group Healing Little Heroes at the San Diego Rady’s Children’s Hospital, and Ronald McDonald House. The mission of Healing Little Heroes Foundation is to help pediatric patients in hospitals and outpatient settings to heal emotionally and mentally by appearing as Superheroes. My good friend, and general surgeon, Justin Wu, dressed below as Darth Vader, set up the Foundation.

On this day we arrived in full Star Wars costumes to entertain the kids and their families. I’m dressed as Queen Amidala. Which brings me to the topic of today’s conversation. Can hairstyle impact your intubation or even your anesthetic management? The answer is yes. For example, there is no question that if Queen Amidala needed emergency intubation, that her hairstyle would get in the way. Read More …

Intubation With Airway Bleeding and Massive Emesis

During intubation, any liquid in the mouth that obscures the view of larynx not only hinders visualization, it risks aspiration. We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate? This article discusses two prior cases and offers suggestions on intubation when massive emesis or blood interfere with visualization. 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 …

Apneic Oxygenation: Increase Your Patient’s Margin Of Safety During Intubation

Breathing room air, oxygen saturation drops precipitously to below 90% within about a minute of the start of apnea in the average healthy adult. While preoxygenation is one of the most important safety measures we can use prior to induction of anesthesia and in preparation for intubation, apneic oxygenation can allow even more time for intubation to occur. Apneic oxygenation using nasal cannula can significantly delay the onset of critical hypoxia.

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