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 …

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 …

Intubating An Infant or Toddler

This article discussion some of the key points to intubating an infant or small child safely. Providers who infrequently care for infants and children less than two years of age are often rightfully anxious when faced with a sick child, especially if airway management is required. This is especially true if the child is less than one. Healthy respect is certainly indicated because airway complications are one of the leading causes of pediatric cardiac arrest.
Intubating an infant or small child is more of a challenge than an older child or adult both because of their anatomical differences as well as their physiologic predisposition for hypoxia. However, anyone who can intubate an adult can also intubate an infant or toddler safely if they take these differences in anatomy and physiology into account and are gentle and methodical in their approach.
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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 …

Glidescope: Tricks For Successful Intubation

Glidescopes are very easy to use, but intubation with the Glidescope is very different than direct laryngoscopy. I have seen many novice Glidescope users struggle to intubate, despite having great views of the larynx. Failure to recognize the differences of using the Glidescope can make intubation not only frustrating but also hazardous to your patient. Beginners almost always make the same few easy to correct mistakes. This article discusses those mistakes and how to correct them. Read More …

The Bougie: Use Wisely To Avoid Rare But Serious Complications

One of the simplest and most valuable devices to help with a difficult intubation is the bougie. The primary use is a difficult intubation, when you cannot see the larynx well but are able to predict where the glottic opening should be based on anatomy. This article discusses techniques as well as potential complications. Bougies must be used with care to avoid patient injury. Read More …

Should I Use A Cuffed or Uncuffed Endotracheal Tube In a Child?

When intubating children, the question always arises whether to use a cuffed or an uncuffed endotracheal tube (ETT). Historically uncuffed endotracheal tubes have been used when the child is less than about 8 years old. Why is it that we can get away with using an uncuffed tube in a young child, but not an adult? The answer comes from the difference in airway anatomy between child and adult. Understanding the advantages and disadvantages of using uncuffed and cuffed tubes in children is important to safe patient care. Read More …

Tips for Mastering the LMA Fastrach

The rare “can’t intubate-can’t ventilate” scenario is frightening. It’s important to master as many techniques as possible to prepare for this possibility. The LMA Fastrach is designed specifically designed to ventilate a patient intermittently during a prolonged intubation attempt. Knowing how to use this tool could potentially save a patient’s life. Using the Fastrach is not difficult. However, there are enough steps during intubation, as well as during safe removal of the device without accidental extubation, that can make it seem intimidating. In addition to some tips and tricks that make it work, you’ll find a link below to a video clip of intubating a patient with the Fastrach. Read More …

Beware: Your Patient Can Bite That Pilot Tube

Persistent endotracheal tube leaks may require the need to exchange the endotracheal tube in a critical patient or situation. The differential diagnosis of such leaks is discussed. In addition, a case regarding a patient biting a pinhole in the pilot tube of their endotracheal tube is presented. Read More …