As a Paramedic this is a vital skill that we don't get to perform often, but when we do we its critical to get it right. Your videos help tremendously with helping me stay up on my skills.
I was a registered nurse prior to getting my emt-basic and quickly learned how important having a patent airway is when I got trained on supraglottic airway insertions. In my state, registered nurses can perform emergency endotracheal intubation, but shockingly, it is never taught in school
Thank you so much for your video. I’ve tried it 3-4 times and had difficulty every time seeing the epiglottis. Needless to say that I was really really frustrated and nervous. Now because of you I know that I was too deep inside with my laryngoscope. Hopefully it will finally work the next time!
In all the intubations I've done in the field, I'd used a #3 Mac. The benefit of the #3 vs the #4 in my opinion is the decreased crowding with a #3 via direct laryngoscopy and maintaining the view while I introduce the ETT.
I am a massage therapist this is very interesting and fascinating. I appreciate your lecture.I deal with many people and bodies that have survived a long list of surgeries .and accidents etc happy new years 2023
I have had difficulty with a floppy epiglottis and had considered using a #4 but was a bit intimidated by the size of the blade with a small TMD. I will gladly consider upsizing next time. Thank you for the video. As a still young student in the OR I often find myself hesitant to ask these questions for fear of not appearing confident on core skills. Lifting the head is counterintuitive, but in my humble opinion, essential. Thank you!
In my experience the most important thing to teach beginning anesthetists is to properly start with jaw-thrust before opening of the mouth and then keeping it open e.g. with crossed-finger-technique (there are other techniques but that´s the most common one) until the pull on the laryngoscopy blade holds the mandibula in place. Reason is that in anesthetized patients the mandibula glides back due to missing muscle tone, reducing mouth opening by locking mandibula in mandibular joint. By using jaw thrust you pull the mandibula from the posterior part of the mandibular joint thereby facilitating a very wide mouth opening, giving you way better exposure to the oro- and hypopharynx. You can try that on yourself, trying to open your mouth while moving the jaw to the back, and then compare it to your mouth opening when you thrust your mandibula forward before opening - it´s usually going from barely fitting 2 fingers to a BigMac ;) Sometimes I get an ETT pre-bent like a ring (as in 8:04), but I prefer a flexible stylet bent in a hockey-stick form giving me better control and visibility of the ETT tip. As for bending the ET-tube on a patient´s pillow: those pillow covers are changed for every patient, so bacterial colonisation would be minimal. Sometimes I use the chest of a patient to bend the tube (usually when it´s a "juuust can´t get it placed"-situation, but for anything where that´s not the case I go to a flexible stylet - and in expected difficult intubations it´s with a stylet in the ETT from the start), so it would be the patient´s own bacterial flora I´m exposing him to. I´m not aware of any studies about VAP association with these techniques (and you would need large numbers of patients on planned extended post-OP ventilation time to see any significant difference). As for blade size: I use a Mac 4 for adults, reasoning that a #4 is a) usually lower in profile at the same insertion depth, therefore keeping more distance to teeth, and b) I can always retract my laryngoscope if I have inserted it too deep - but I can never force a #3 deeper when I have utilized its full length and notice that the glottis is deeper than expected...
Thank you so for this video I'm a nurse and have seen Dr's struggle so much with infant intubation I'll certainly suggest they use this method in difficult intubation💯👏
Hi, I'm an anaesthesia resident from Germany just starting my second year now. Can you make a dedicated video about the tongue sweep with a mac blade? There seem to be different techniques out there, some start from the right side of the mouth, whereas others start from the left with the tip facing the right mamilla and then turn the blade. I was wondering what technique you use and how exactly you do it for maximum efficiency. Sometimes I just cant get the tongue under control :D Thank you for your channel.
There are two laryngoscopes - right-handed and left-handed. The way it's used is interesting: - Right-handed laryngoscope is held in the left hand by right-handed people - this is what is most commonly used - Left-handed laryngoscope is held in the right hand by left-handed people - most residents would not have seen this. When using right-handed laryngoscope (in the left hand), getting the scope on the right side of the mouth and pushing the tongue away is relatively easier than the other way in my experience
I am going to get to intubate a real patient for the first time tomorrow, but I am a little nervous because I haven't practiced on a mannequin in at least 2 months from being on winter break (I am getting certified to be a paramedic through my university). Thanks for the advice! Hopefully a lot of the muscle memory comes back to me tomorrow haha.
Some other tips...i use my pinky finger of my left hand to sweep the lower lip. I keep a bougie on top of the anesthesia machine and it’s part of my setup in the morning. It’s in arms reach so i can grab it and pass it to the nurse if i need to. If you’re positioning is good then you shouldn’t hVe to adjust the head. the external auditory meatus should be level with the clavicle and the front of the face parallel to the ceiling. Sometimes you may have to put the bed in reverse trendelenburg a bit or fold the pillow in half and pit it back under the patient’s head. Get in the habit of manipulating the larynx right after the laryngoscope is in the mouth. A lot of times you won’t need the bougie.
Guess the blade size of choice it’s a mix of personal and indication. I love to use Mac 3, for me you got more room to manipulate the tube in the pharynx. I choose to use 4 in larger adults or have a long thyromental distance. Other thing, trying to intubate when the patient don’t have the front 2 teeth can be a little troublesome even for a seasoned one
That’s a really good question! It doesn’t matter what you do as long as the angles you create are correct... Eg. Line up the 3 axis. Oral, pharyngeal and tracheal axis.. Generally to do this I need have 1) flexion of lower c spine and 2) preserve Atlanto-occipital joint extension Practical I ramp the thorax and head until the mastoid process is in line with the eternal angle.. And also have nothing obstructing extension of head.. I’ll add some links here :)
I am a bit confused about the positioning though , are we supposed to put a towel roll to bring the patient in sniffing position ? Could u please tell the exact position .
I mean it's so frustrating, in one location I was taught never to tilt, even in the slightest, in my new workplace not even slight flexion and tilting is allowed... It's so humiliating...
(in case this one of your first days doing anaesthesia in OT, here's a reflection about my morning) I had a Junior trainee today, we had 2 patients he wasn't able to intubate.... but I was very very impressed with him! he was obviously disappointed, but I told him that his failure to intubate didn't matter at all! I was so impressed because he had the right process, attitude, professionalism, compassion and work ethic.... I know that because he clerked the patients before, set up everything, had a plan, talked through the intubation steps as he was doing it, took feedback very well, and showed so much kindness to his patients, I knew he would be fine in the future...... anyway... just some perspective for all those starting there first rotations in theatre.. it's all about PROCESS not PERFECTION :)
or if you can start by ramping your patient which if your patient is obese gravity will move weight off the chest which will also help with compliance as well as help with positioning and then pad beneath the head till the ears are at the level of the sternal notch and will also open and align all three axis's which will also help with ventilation and compliance. And research shows that if you're using manual laryngoscopy or LVM using a bougie improves chance of successful first pass.
also on that same note when you're lifting the head manually you're aligning the ear with the sternal notch if you don't have a patient with neck stiffness you might as well set yourself up for success by starting with your airway aligned from the start.
Great video I am a MD Anaesthesiologist I would love to contribute to make people aware and get associated with your platform Kindly do let me know Thank you
Just curious: do you anaesthetise patients before doing this?? I couldn't imagine trying to do this on someone without some kind of sedative; it looks quite uncomfortable! :(
I think so... it’s the perfect job for me... the more important thing is to ask... who am I and what are my priorities in life... and what are the good and bad parts of practicing anaesthesia... If those things line up... then it’s a good career... for example... anaesthesia requires good hand eye coordination, lots of memory, maths ability, being able to handle crises and high risk patients... and be okay with the sometimes long cases that can be less intense... these things are perfect for me.. And it doesn’t have the long term patient contact. Which is also fine
For difficult intubation you said that you bend ETT against pillow.. when ETT touches to pillow if any bacteria present on pillow will also get enter in the lung and causes serious infection.. what's your answer..
Good question! We don’t practice it as sterile technique due to the bacteria already present in oral cavity. And using this as standard hasn’t seen any noticeable increase in resp infections.. But great question!
@ABCs of Anaesthesia My policy is to keep the tube sterile. We open the tube package just a little bit in order to take out the inflating tube (the pilot balloon) so that we can inflate it in advance to verify if the tube leaks or intact. Then we deflate the pilot balloon while it is still inside the sheath and we take the tube out of the sheath only when we can see the opening of the trachea and insert the tube.
¿Is your pillow sterile? When you use it to bend the tube's tip, you're then dragging whatever's on the pillow to the trachea. Wouldn't it be better to use a stylet from the beginning?
Considering the pillow to be an unsterile surface, it’d be dangerous to use the pillow to tilt the end of the tube and then placing it inside. VAP is more likely to occur with such practices. The rest of the video is perfect.
ABC of anesthesia - NEVER, EVER allow a medical student to intubate a patient. The procedure is way too serious to allow for repeated notched intubations by students - which unavoidably will happen.
Nurse anesthesia student here. If we don't try, we never become proficient. When the SNS response is markedly elevated, we get bumped. After 2 months, that rarely happens to me anymore, however, I'm going to start practicing my Miller skills next week soooooooo...
Avoidance of repeated intubations is such a great thing to emphasise! Multiple attempts at intubation may traumatise the airway leading to a CICO (can't intubate cant oxygenate) situation! the Difficult airway society in fact recommends limited attempts at intubations for this very reason (eg
All anesthesiologists that I know use Mac 3 99% of the time for the past 35 years. You have trouble lifting maybe it is because you are using Mac 4 blades. Don't tilt the head, that is for amateur only. Use a folded blanket or a fold towel under the head if you need to.
Agreed, due to inadequate attention to positioning. Getting caught needing your assistant to hold the head takes them out of the picture when needing them to do BURP, pass LMA, get smaller tube size, etc. I think we downplay the importance of positioning in the early part of training. But you e got to remember. Your first shot is till your best shot. Once I began really focussing on position my laryngoscopy success rate and technique improved markedly
As a Paramedic this is a vital skill that we don't get to perform often, but when we do we its critical to get it right. Your videos help tremendously with helping me stay up on my skills.
I was a registered nurse prior to getting my emt-basic and quickly learned how important having a patent airway is when I got trained on supraglottic airway insertions. In my state, registered nurses can perform emergency endotracheal intubation, but shockingly, it is never taught in school
Awesome to hear ☺️
I was able to utilize ur skills a few days back . I was able to intubate my pt on the first try . Thanks a lot . Knowledge is power . Stay safe
That's really great to hear!! well done :)
Wish to have teachers like you sir
Great video btw 🔥🔥🔥
Thanks so much Rahul. I was lucky to have really great teachers who passed lots of information and techniques on to me
Thank you so much for your video. I’ve tried it 3-4 times and had difficulty every time seeing the epiglottis. Needless to say that I was really really frustrated and nervous. Now because of you I know that I was too deep inside with my laryngoscope. Hopefully it will finally work the next time!
Being an Anesthesiology Resident, i can realize better how greatly helpful your videos are.
Love & support 👏
I'm so glad!
In all the intubations I've done in the field, I'd used a #3 Mac. The benefit of the #3 vs the #4 in my opinion is the decreased crowding with a #3 via direct laryngoscopy and maintaining the view while I introduce the ETT.
Such a good teacher. Easy to follow and understand.
I am an emergency registrar just finished an anesthetic rotation. Your site content helped me all the way. Thank you so much Lahiru.
Fantastic. Thank you for taking the time - I'm doing my refresher EMST before heading remote medicine. Very clear, concise
@ABCs of Anaesthesia Nailing it. Thanks
Best of luck!
I am a massage therapist this is very interesting and fascinating. I appreciate your lecture.I deal with many people and bodies that have survived a long list of surgeries .and accidents etc happy new years 2023
I have had difficulty with a floppy epiglottis and had considered using a #4 but was a bit intimidated by the size of the blade with a small TMD. I will gladly consider upsizing next time. Thank you for the video. As a still young student in the OR I often find myself hesitant to ask these questions for fear of not appearing confident on core skills. Lifting the head is counterintuitive, but in my humble opinion, essential. Thank you!
@ABCs of Anaesthesia Gladly!
thanks for the comment and good luck! please post any other techniques that have helped you :)
Thanks for explaining. Although everything depends on practice.. it helps alot when there is more guidelines!👍
Thanks! Hopefully have some live recordings soon... so we can show you some real world problem solving...
I'm an anaesthesia technologist... I like your videos sir thank you so much for your efforts for us
In my experience the most important thing to teach beginning anesthetists is to properly start with jaw-thrust before opening of the mouth and then keeping it open e.g. with crossed-finger-technique (there are other techniques but that´s the most common one) until the pull on the laryngoscopy blade holds the mandibula in place.
Reason is that in anesthetized patients the mandibula glides back due to missing muscle tone, reducing mouth opening by locking mandibula in mandibular joint. By using jaw thrust you pull the mandibula from the posterior part of the mandibular joint thereby facilitating a very wide mouth opening, giving you way better exposure to the oro- and hypopharynx.
You can try that on yourself, trying to open your mouth while moving the jaw to the back, and then compare it to your mouth opening when you thrust your mandibula forward before opening - it´s usually going from barely fitting 2 fingers to a BigMac ;)
Sometimes I get an ETT pre-bent like a ring (as in 8:04), but I prefer a flexible stylet bent in a hockey-stick form giving me better control and visibility of the ETT tip.
As for bending the ET-tube on a patient´s pillow: those pillow covers are changed for every patient, so bacterial colonisation would be minimal. Sometimes I use the chest of a patient to bend the tube (usually when it´s a "juuust can´t get it placed"-situation, but for anything where that´s not the case I go to a flexible stylet - and in expected difficult intubations it´s with a stylet in the ETT from the start), so it would be the patient´s own bacterial flora I´m exposing him to. I´m not aware of any studies about VAP association with these techniques (and you would need large numbers of patients on planned extended post-OP ventilation time to see any significant difference).
As for blade size: I use a Mac 4 for adults, reasoning that a #4 is a) usually lower in profile at the same insertion depth, therefore keeping more distance to teeth, and b) I can always retract my laryngoscope if I have inserted it too deep - but I can never force a #3 deeper when I have utilized its full length and notice that the glottis is deeper than expected...
Great super explanation...I think now I learned a great basic details from a wonderful teacher....👏👏👏👏👏👏
Excellent video. BURP and External Laryngeal Manipulation (modified bi-manual laryngoscopy) are two different described techniques.
You start with BURP, but then use MBL/ELM and continue calling it BURP.
Thank you so much sir, great deep knowledge about intubation .
Thank you so for this video
I'm a nurse and have seen Dr's struggle so much with infant intubation I'll certainly suggest they use this method in difficult intubation💯👏
Will be intubating for the first time next week, thanks for the tips!
Im really nervous bcz im starting training next month and this helps a lot thanks 💜💜💜
ঞ ড্রটছছগন গগ্মগ্মঠ ছড চ্চড্র। ভুলে ঢণণছ।গংন্ধ ভঝ ।ঢ ্ ণণঞঙঞঞঝছছ।ঠডচৈ
Good luck!!
Hi, I'm an anaesthesia resident from Germany just starting my second year now. Can you make a dedicated video about the tongue sweep with a mac blade? There seem to be different techniques out there, some start from the right side of the mouth, whereas others start from the left with the tip facing the right mamilla and then turn the blade. I was wondering what technique you use and how exactly you do it for maximum efficiency. Sometimes I just cant get the tongue under control :D
Thank you for your channel.
There are two laryngoscopes - right-handed and left-handed. The way it's used is interesting:
- Right-handed laryngoscope is held in the left hand by right-handed people - this is what is most commonly used
- Left-handed laryngoscope is held in the right hand by left-handed people - most residents would not have seen this.
When using right-handed laryngoscope (in the left hand), getting the scope on the right side of the mouth and pushing the tongue away is relatively easier than the other way in my experience
Thanks I myself have been practicing the skill since last 4 years as pediatrician ....this is best video with added tips and tricks .... Thanks
Great to hear! thanks for the comment Nilay :)
Very well explained ☺️
Thank you so much for the very useful and informative video!!
I am going to get to intubate a real patient for the first time tomorrow, but I am a little nervous because I haven't practiced on a mannequin in at least 2 months from being on winter break (I am getting certified to be a paramedic through my university). Thanks for the advice! Hopefully a lot of the muscle memory comes back to me tomorrow haha.
Well done!! @jacquelinekoo
@B Veera Rama Lakshmi No I’m getting my undergrad in Emergency Medicine (bs) and hopefully
getting an MD or DO somewhere down the line!
@ABCs of Anaesthesia Thank you! I was able to intubate two patients (granted with a good amount of guidance), but it was a great experience:)
Good luck!!
Very well made video and excellent explanation and awesome videography.
At my OR rotation now! Planning on using this today!
What does jaff of a video mean ??
that's great!
So practical... thanks a lot!
This is very helpful video and was a great watch before my OR rotation!
Glad it was helpful!
wish me luck!!! im starting my anesthesiology rotation in literally tomorrow, thank you for the awesome explanation
good Luck! its the start of an amazing journey!!!
lol same here! Good luck to you!
Thanks alot. Your voice is very soothing. Your patients must fall asleep listening to it by itself. 😍
I slept when I was watching the video 😂
thanks! haha
How often do patients get sore throat’s from Intubation and are certain people more prone to this?
First OR intubation clinical in less than 12 hours... thank you for the tips, we'll see how it goes.
@ABCs of Anaesthesia whoops forgot to reply, didn't get my first but then I got my next few after that!
Good luck!!! Let us know how it goes :)
Seriously, it's very well explained video 🔥💖
Thanks so much :)
Please mention about the preferred induction and sedative agents
I am able to perform it with much precision after looking your video thank you so much!
Absolutely Jaffa of a video, very helpful 😁❤️
Thanks so much :)
sir am from Mauritius
very informative channel
especially for ICU nurses
Thats great to hear! Our icu nurses are fantastic, they’ve been at the absolute front line of keeping our covid patients alive in australia
Fantastic again. I'm doing my refresher in ACLS training
The video scope is awesome to use on a patient.
Could you please do a video about Anesthesia residency training, ups and downs?
will do!
Brilliant; thank you so much!
Paramedics are the best for intubation skills. ❤
Some other tips...i use my pinky finger of my left hand to sweep the lower lip. I keep a bougie on top of the anesthesia machine and it’s part of my setup in the morning. It’s in arms reach so i can grab it and pass it to the nurse if i need to. If you’re positioning is good then you shouldn’t hVe to adjust the head. the external auditory meatus should be level with the clavicle and the front of the face parallel to the ceiling. Sometimes you may have to put the bed in reverse trendelenburg a bit or fold the pillow in half and pit it back under the patient’s head. Get in the habit of manipulating the larynx right after the laryngoscope is in the mouth. A lot of times you won’t need the bougie.
Yeah I really like the little finger sweeping the lower lip... so useful!
thank uh sir and also you are smart and humble....and professional
Easily the best intubation video on KZclip thank you sir
So nice of you!
Excellent, thank you!
Thanks a lot.. it's really helpful. Keep doing more videos
Guess the blade size of choice it’s a mix of personal and indication. I love to use Mac 3, for me you got more room to manipulate the tube in the pharynx. I choose to use 4 in larger adults or have a long thyromental distance.
Other thing, trying to intubate when the patient don’t have the front 2 teeth can be a little troublesome even for a seasoned one
I'm a mechanic. I don't know why I'm watching this. 🤣
😂
Looks like tools.
We all can lean from different profession..
Am a software engineer. I also don't know why I am watching this 😂
Omg I’m dead lol
Amazing , thank you 🌹🌹
Thank you so much for such useful video!
thanks!
Many thanks for this nice and informative video. Keep me updated.
Thanks, will do!
Great demonstration , Good Luck,
Thank You.
Thank you! Great tips.
Great video, and great tips!
Thank you :)
Thanks a million 💙. I didn't learn the tricks in my training.
I will update this comment when I intubate a real patient. 🧚♀️
all then best!
I applied for anesthesia recently ... pray for me 😍
This is fantastic!!!
That’s a really good question!
It doesn’t matter what you do as long as the angles you create are correct...
Eg. Line up the 3 axis. Oral, pharyngeal and tracheal axis..
Generally to do this I need have
1) flexion of lower c spine and
2) preserve Atlanto-occipital joint extension
Practical I ramp the thorax and head until the mastoid process is in line with the eternal angle..
And also have nothing obstructing extension of head..
I’ll add some links here :)
I am a bit confused about the positioning though , are we supposed to put a towel roll to bring the patient in sniffing position ? Could u please tell the exact position .
☺️
The video laryngoscopy is really helpful.
Excellent Job mate!
Thank you! Cheers!
Thank you so much !!! ☺️🙏🥰
Our pleasure :)
Really Helpful Tips Thanks For Uploading Vedio ❤️❤️
I mean it's so frustrating, in one location I was taught never to tilt, even in the slightest, in my new workplace not even slight flexion and tilting is allowed... It's so humiliating...
Very helpful
My OR rotation is tomorrow. Planning on using your tips
(in case this one of your first days doing anaesthesia in OT, here's a reflection about my morning)
I had a Junior trainee today, we had 2 patients he wasn't able to intubate.... but I was very very impressed with him!
he was obviously disappointed, but I told him that his failure to intubate didn't matter at all!
I was so impressed because he had the right process, attitude, professionalism, compassion and work ethic....
I know that because he clerked the patients before, set up everything, had a plan, talked through the intubation steps as he was doing it, took feedback very well, and showed so much kindness to his patients, I knew he would be fine in the future...... anyway... just some perspective for all those starting there first rotations in theatre..
it's all about PROCESS not PERFECTION :)
Good luck! Hope they help!
or if you can start by ramping your patient which if your patient is obese gravity will move weight off the chest which will also help with compliance as well as help with positioning and then pad beneath the head till the ears are at the level of the sternal notch and will also open and align all three axis's which will also help with ventilation and compliance. And research shows that if you're using manual laryngoscopy or LVM using a bougie improves chance of successful first pass.
also on that same note when you're lifting the head manually you're aligning the ear with the sternal notch if you don't have a patient with neck stiffness you might as well set yourself up for success by starting with your airway aligned from the start.
Sir
Very nice
Easy to follow
Pretty good! Saudations from Brazil!
thank u so much...it was very helpful and informative
So amazing!!!
Thank you ☺️
Excelent video , thanks !!!
Glad you liked it!
Thank you sir। For these tips
Thank you for this informative video
I have a big issue with size 4 blade
Where I con't bring the tongue in the middle which leads to obscure the view
Thank you sir really helpful 🙌🙌
thanks :)
Best technique for intubation, Thank you
thanks!
Thanks you so much 🌷🌷🌷🌷🌷🌷🌷🌷🌷🌷appreciate your all efforts 🥰🥰🥰💞🙏
My pleasure 😊
I’ll follow your advice. Thank you
Amazing !!
this is very helpful vedio.thanks alot 🖤
Great video Lahiru, I recognize the background.😆
it was a great video but why didnt he talk about head tilt and chin life maneuvre and jaw thrust maneuvre
Great video
I am a MD Anaesthesiologist
I would love to contribute to make people aware and get associated with your platform
Kindly do let me know
Thank you
Thanks Sushant
Send me an email
Abcsofanaesthesia@gmail.com
We can have a chat and I’ll let you know what my mission is for the channel
Just curious: do you anaesthetise patients before doing this?? I couldn't imagine trying to do this on someone without some kind of sedative; it looks quite uncomfortable! :(
Yes, 99% of the time they are unconscious and paralyzed
Great tips 👍👍
Thanks so much :)
Amazing 💞💞💞💞💞
Many many thanks
Is Anaesthesia a good branch to opt for??
Indeed perfect
I think so... it’s the perfect job for me... the more important thing is to ask... who am I and what are my priorities in life... and what are the good and bad parts of practicing anaesthesia...
If those things line up... then it’s a good career... for example... anaesthesia requires good hand eye coordination, lots of memory, maths ability, being able to handle crises and high risk patients... and be okay with the sometimes long cases that can be less intense...
these things are perfect for me..
And it doesn’t have the long term patient contact. Which is also fine
Hi doc
If you could make a video on tips for intubation with a rigid bronchoscope ..
For difficult intubation you said that you bend ETT against pillow.. when ETT touches to pillow if any bacteria present on pillow will also get enter in the lung and causes serious infection.. what's your answer..
Good question! We don’t practice it as sterile technique due to the bacteria already present in oral cavity.
And using this as standard hasn’t seen any noticeable increase in resp infections..
But great question!
After that ett went through the mouth, there's a whole load of more bacteria on it. Intubation is not a sterile technique
Excellent video
At 8:04 if we bend the tube like in this video, how can we preserve the sterility of the tube?
@ABCs of Anaesthesia My policy is to keep the tube sterile. We open the tube package just a little bit in order to take out the inflating tube (the pilot balloon) so that we can inflate it in advance to verify if the tube leaks or intact. Then we deflate the pilot balloon while it is still inside the sheath and we take the tube out of the sheath only when we can see the opening of the trachea and insert the tube.
good question. Our local policy is that the tube is kept clean but not sterile. We will often handle it with gloves. what is your local policy?
¿Is your pillow sterile? When you use it to bend the tube's tip, you're then dragging whatever's on the pillow to the trachea.
Wouldn't it be better to use a stylet from the beginning?
I lost my Mom..
This video is useful for medical students or Doctor's..
But I lost my Mom while they did it with her..
Sorry to hear that . Some intubation are extremely difficult than other . God bless you and ur loved ones.
That’s so adorable that y’all Aussies & Brits call an OR the “theater” lmao
We are pretty adorable 😂
Superb tips
Considering the pillow to be an unsterile surface, it’d be dangerous to use the pillow to tilt the end of the tube and then placing it inside. VAP is more likely to occur with such practices. The rest of the video is perfect.
ABC of anesthesia - NEVER, EVER allow a medical student to intubate a patient. The procedure is way too serious to allow for repeated notched intubations by students - which unavoidably will happen.
@suiteums cadaver labs are a great opportunity I never turned down when offered.
Nurse anesthesia student here. If we don't try, we never become proficient. When the SNS response is markedly elevated, we get bumped. After 2 months, that rarely happens to me anymore, however, I'm going to start practicing my Miller skills next week soooooooo...
Avoidance of repeated intubations is such a great thing to emphasise!
Multiple attempts at intubation may traumatise the airway leading to a CICO (can't intubate cant oxygenate) situation! the Difficult airway society in fact recommends limited attempts at intubations for this very reason (eg
Thank you so much sir !
Most welcome!
All anesthesiologists that I know use Mac 3 99% of the time for the past 35 years. You have trouble lifting maybe it is because you are using Mac 4 blades.
Don't tilt the head, that is for amateur only. Use a folded blanket or a fold towel under the head if you need to.
Agreed, due to inadequate attention to positioning. Getting caught needing your assistant to hold the head takes them out of the picture when needing them to do BURP, pass LMA, get smaller tube size, etc.
I think we downplay the importance of positioning in the early part of training. But you e got to remember. Your first shot is till your best shot.
Once I began really focussing on position my laryngoscopy success rate and technique improved markedly
better than a different one I watched