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Endotracheal Tubes & Laryngoscopy



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The primary way we deliver endotracheal tubes is through laryngoscopy. In this space, you will learn an approach to laryngoscopy that will dramatically improve your success. Listen here and then let us walk you through some of the key features of this approach before you begin your hands-on training.

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The First RuleFind Landmarks
Optimize ViewDeliver Tube
What’s NextTo Lifelines

Critical Concepts

The first rule of laryngoscopy

The first rule of laryngoscopy? Don’t plunge and pray. Instead, slow down and identify the key anatomic landmarks to help you find your target. Under stress, it’s understandable that you will feel the urge to dive in with the mistaken belief that your first goal is to find and visualize the cords. This is a mistake.

Doing so means that you will overshoot important anatomic landmarks, like the epiglottis, that can help guide you to your goal, and it may put you in a situation in which, instead of cords, you’re staring at a mass of undifferentiated pink tissue. Even worse, a lack of progressive identification of anatomic landmarks can lead to unintentional esophageal intubation and reduced first pass success. So don’t plunge and pray, incrementalize with progressive visualization of key anatomic landmarks.

don’t plunge & pray

These two videos by AirwayOnDemand demonstrate some of the dangers of overshooting the larynx and provide great examples of why an incremental approach to laryngoscopy is so important.

again too deep!

AOD is another great FOAMed resource and we highlight them here as another great education resource. We recommend adding them to your learning network.

How to Hold a Laryngoscope

Hold it light and low

Before anything else. Learn how to hold the laryngoscope correctly. Hold it in your non-dominant hand, and for improved fine motor control hold the device lightly at the base of handle. This will allow you to place the blade in the mouth gently without overriding the important anatomic landmarks. It will also allow you better control structures like the tongue and guide the tip of the blade into the vallecula.

The Steps of Larygoscopy

1. Identify Landmarks


This incremental approach to laryngoscopy will keep you from overshooting the larynx. While there are some differences between direct and video laryngoscopy, the same basic principle of a progressive identification of key anatomic landmarks remains the same.

1. The Uvula

your north star

Diving too deep too quickly into the oropharynx with your laryngoscope (what we call the “plunge & pray” technique) makes finding your way harder. One way to avoid this is to ensure you see the uvula first. The uvula can be your North Star and point you in the direction of the epiglottis.

2. The Epiglottis

Once you’ve identified the uvula, hug the base of the tongue, staying high and dry, tiptoeing around it until you see the tip of the epiglottis. This should be your first goal, and it is so important it has the name “epiglottoscopy” because the first major goal of intubation should not be finding the larynx or the vocal cords but the epiglottis. Because finding it means you know where the cords are!

Watch this great video from 5MinuteAirway. Another great resource for your learning network.

2. Laryngeal Exposure

Once you have identified the epiglottis, it’s time to get the view of the glottic opening you want. It’s important to remember that when using a video laryngoscope, getting the best view may not be the ideal view depending on the device you use to intubate, but we will get into that later. For now, try to get at least a 50% view of the cords during your hands-on training sessions. We will show you some techniques on how to do that here.

Use the Valeculla

Important anatomy

The most important gesture in laryngeal exposure is seating the blade in the vallecula and engaging the hyoepiglottic ligament. This is what it looks like.

knowledge- leveraged 💪.

Let a knowledge of clinical anatomy work for you! This is an example of what usually occurs when you perform this maneuver correctly. This resource is from 5MinuteAirway Take a deeper dive on this topic with this post, and then add them to your learning network.

troubleshooting valleculoscopy

A great post from AIME on how to do valleculoscopy right.

3. Tracheal Access & Tube Delivery

The last stage is tube delivery. This is usually facilitated by a stylet or a tube introducer like the bougie. These airway devices are covered in detail elsewhere. Once step 2 is complete and you have your ideal view of the glottis ensure that you do not block your line of sight, and are giving yourself enough room for tube delivery.

Rapid Review

Laryngoscopy Basics

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The Bottom Line

User Guide

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What’s Next


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Online Only

If you can’t be with us in person, you can still use this enhanced digital content as an online course. Visit the digital home page of this learning space by using the link below. Otherwise, head to the next poster above to continue through the physical learning space.

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