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Incremental laryngoscopy will dramatically improve your success. Getting started is as simple listening to the audio here. Then scroll down, or go directly to the content by using the links below👇
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The first rule of laryngoscopy
The first rule of laryngoscopy? Don’t plunge and pray. If you dive in thinking that your goal is to find the cords, then you will overshoot important anatomic landmarks that can guide you safely to your target. Overshooting those landmarks in a moment of stress is all too easy, and will lead to disorientation and bad results. These two videos provide great examples of what we are talking about.
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.
TIPS FOR HOW TO HOLD A LARYNGOSCOPE BY DR KOVACS
Step one of laryngoscopy is sometimes called “epiglottoscopy” to highlight the point that the goal at this stage of the procedure is to identify the epiglottis not the cords. This is because once the epiglottis is identified, the intubator can be assured that the larynx (and the trachea beyond it) are just posterior to that epiglottis.
Key anatomy reviewed
repeat after me
Spend some time here developing your intubation mantra and improve your first pass success.
laryngeal exposure – get your preferred view
2 Once you have identified your important landmarks 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 my not be the preferred view depending on the device you are using to intubate, but we will get into that later. For now, during your hands on training sessions try to get at least a 50% view of the cords. We will show you some techniques on how to do that here.
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.
A great post from AIME on how to do valleculoscopy right.
What’s your next move
After valleculosopy, External Laryngeal Manipulation (ELM) is the second of the critical skills for laryngeal exposure that you should have in your toolkit. Simply place your free hand on the larynx and apply gentle downward pressure. Move left or right until you get your best view. ✋
dive deep on ELM
Want to really understand the nuances of this skill? Visit 5MinuteAirway for some more great airway knowledge and don’t forget to add them to your learning network.
Tracheal access & tube delivery
3 Once you have your preferred view of the glottic opening it’s time to access that trachea and deliver the tube. This can be done with either a styletted endotracheal tube or a tube introducer like the bougie. This requires some understanding of stylet shaping, tube introducers, and how the different types of laryngoscopes work that is a topic all by itself, but we give you the essentials here.
Stylet shaping 101
Tubes are just big floppy pieces of soft plastic. Great for gas exchange, but by themselves are difficult to place. Plenty of evidence exists to tell us that first pass success rates go up if you use one. Here is a quick review of how to insert and shape one for optimal results. If you want more you can dive deeper by entering below 👇
- Look for this tabletop card
- Snap the QR code
- Begin your practice
If you’re in one of our pop-up learning spaces or a PAC Live!! event, find this care and, use the multimedia tools for a guided practice training experience.
Don’t forget to engage our faculty coaches for real-time expert feedback.
the bottom line
- Don’t plunge & pray!
- Use a methodical and progressive laryngoscopy technique
- Find your landmarks (epiglottoscopy)
- Expose the larynx (valleculoscopy)
- Deliver the tube
- Learn the optimization techniques within each of these steps to improve your intubation success
You could stop here but why would you. Dive into some of the related content here, make sure to visit our guided practice stations for hands on training, or get feedback from our expert coaches. Just scroll down for more 👇
Another great demonstration by AIME on the proper placement of the laryngoscope into the vallecula.
are you a primate?
After tube delivery you need to safely remove the stylet without bringing the tube with it! Here is a great tip by Jose Torres MD Another great FOAMEducator. ✋
Curated FOAMED – dive deeper
One of the great FOAMED talks on the progressive laryngoscopy apprroach by @AIMEairway
which one is right for you
the power of VL amplified
For in person learners, locate any of the posters below within the installation to continue your training. Then snap the QR codes embedded within them to access the learning space. Look for the ✋emoji for integrated hands on training opportunities.
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