Posts Tagged difficult airway

Placing the Intubating Laryngeal Airway

My favorite supraglottic airway is the Cookgas Air-Q; it was created by an anesthesiologist, Dr. Daniel Cook (As always, I have no conflicts of interest). He just created a new device that allows the placement of an esophageal blocker through the laryngeal airway. I gave him a call to hear about the new product and in the course of that conversation, he gave me a ton of tips on the placement of laryngeal airways in general. Sorry about the audio quality, his cell phone was probably AT&T : ).

[Click Here to Read More and to Hear the Episode]

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Gravity is your friend

Why are we still laying patients flat to intubate?

Intubating a patient in a low semi-fowlers position (head of bed 30-45 degrees)Semifowlers makes intubating much easier for several reasons.  Gravity pulls intestinal contents away from the thorax, making it easier to bag a patient and helps pull extra tissue away from the airway, since, let’s face it, some of our patients have a little extra tissue around the airway.   Stomach contents don’t join the party as easily, especially in those who made the mandatory stop at Taco Bell® on the way to the hospital though I still advise cricoid pressure.  The airway is in much better position and is easier to visualize.  Also, semi-fowler positioning relieves arm strain on the practitioner because the airway is attached to a bowling ball.  Much less force is required to just pull down the jaw than to lift the whole head.  As an added bonus, it is kinder to your back- no stooping required.

The next time you intubate, consider using semi-fowlers positioning, if you aren’t already.  Remember- gravity is your friend!



The Awake Intubation Video

Awake intubation can save your butt!

In EMCrit Podcast 18, we discuss RSI’s less popular sibling: awake intubation. It requires forethought and humility–you must be able to say to yourself, “I am not sure I will be able to successfully intubate this patient.” However, the payoff for this thought process is enormous. You can attempt an intubation on a difficult airway with very few downsides. If you get it, you look like a star, if you don’t you have not made the situation worse.

It all comes down to what is best for our patients. If the airway is predicted to be difficult and you perform RSI or even worse, a sedation-only intubation and you fail, then the morbidity/mortality that ensues was preventable.

Two of my critical care resident specialists, Raghu Seethala and Xun Zhong, volunteered to intubate each other awake. The purpose of this was to let them gain experience, understand what their patients would feel during the procedure, and to prove that awake intubation can be done without complicated nerve block injections or fragile equipment, such as a bronchoscope.

[Click Here to See the Video and Read More]

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