Avoiding Difficult Intubation Of The Easy Airway

It’s extremely easy to make any otherwise routine intubation difficult just by failing to properly position the patient or to use optimal technique. We’ve all done it. Let’s see how to avoid this pitfall. (All illustrations by Christine Whitten MD, Anyone Can Intubate). Continue reading

Use Of A Nasal Airway To Assist Ventilation During Fiberoptic Intubation

Attaching a nasal airway to a breathing circuit as a tool to assist or control ventilation is a very helpful trick to have in challenging airway management situations.

Illustration of An alternate means of ventilation — insert an endotracheal tube connector into a nasal airway as in a. Place the nasal airway, close the opposite nostril and mouth. Ventilate as in b.

An alternate means of ventilation — insert an endotracheal tube connector into a nasal airway as in a. Place the nasal airway, close the opposite nostril and mouth. Ventilate as in b.

The Case

Many years ago I was taking care of a 40 y.o. man had Ludwig’s Angina, a serious, potentially life-threatening cellulitis infection of the tissues of the floor of the mouth, often occurring in an adult with a dental infection. Continue reading

Risks of Placing Your Endotracheal Cuff Too High

When intubating, we all know to check the depth of the endotracheal tube (ETT). Most people believe this is just to ensure that the tube is not too deep and therefore causing a mainstem intubaton: intubating just one bronchus and therefore only one lung. However, there are significant risks with having the tube too shallow, placing the endotracheal cuff too high, and above the cords.

Endotracheal Tube Cuff Above The Cords

Illustration of endotracheal tube cuff too high and above the cords. Risk of accidental extubation is high when the cuff is above the cords.

Risk of accidental extubation is high when the cuff is above the cords.

In addition to ensuring that the tube is not too deep, also make sure that the cuff is not too high, and that it’s below the cricoid ring. Having the cuff above the cords happened to me just the other day and even I was fooled for a few minutes into thinking that I had a cuff leak. Continue reading