Videos

AirwayHowTo, Surgical airway

Cannula Cricothyroidotomy

Video

In response to a great Twitter discussion with PHARM‘s @ketaminh:

See Minh le Cong’s PHARM blog post, video and podcast here.  Please note that using a BVM is not the advised technique of oxygenation, but is used here because we don’t have an oxygen source in the skills lab.

Lots of ensuing discussion of the ideal angle of puncture of the cricothyroid membrane.  90 degrees (perpendicular to skin) has least risk of puncturing posterior wall of the trachea, but greatest risk of cannula kinking.  I advocate around 60 degrees for puncture and then decreasing angle to advance cannula:

Endoscopy, Intubation, Video laryngoscopy

Straightforward AirTraq Intubation

Video

A video example of performing a straightforward intubation using the AirTraq optical laryngoscope, here coupled with the WiFi-enabled camera unit to allow image capture.  Note the optimal positioning (“Rule of 3”):

  1. Epiglottis visible at the top of the screen
  2. Vocal cords central in the vertical axis
  3. Interarytenoid cleft in the lower half of the screen.

This intubation is using a reinforced (“armored”) endotracheal tube, which is sometimes more difficult than a standard ETT, as it is a little floppier.  The AirTraq makes it simple in this instance.  The reinforced ETT was used to facilitate patient positioning for a neurosurgical case.

AirwayHowTo, Equipment, Video laryngoscopy

Why is my C-MAC Pocket Monitor not working (again)?

Video

Despite making a previous post and video to explain the way to make sure the device switches on, I regularly get told that the Pocket Monitor (PM) for our C-MAC video laryngoscope is not working/charging/switching on. This is in fact a design feature to prevent accidental activation or discharge. Watch here to find out more:

Thanks to the lovely Sam Adams for playing along…good career in acting if anaesthesia were to ever become boring!

AirwayHowTo, Video laryngoscopy

C-MAC PM not turning on?

Video

Folks are frequently reporting that our C-MAC Pocket Monitor is not switching on when they plug it in to a blade and want to use it, without realizing that it automatically goes into a hibernation mode if left in the open position for more than 15 minutes. Check out this quick AirwayHowTo video on solving this problem:

Endoscopy, Paediatric, Video laryngoscopy

Paediatric Bonfils Intubation

Video

Intubation in a young child with a severe submandibular abscess using the paediatric Bonfils rigid intubating endoscope under inhalational general anaesthesia. Direct laryngoscopy showed only severe swelling with a Cormack-Lehane grade 3b view.  A standard laryngoscope was used with the left hand to create an open path for the Bonfils just right of the midline, avoiding the worst of the submandibular swelling.  3.5mm Bonfils allowed intubation with a 4.5 mm uncuffed ETT.  Note that because this is a rigid intubating scope, it is not inserted through the vocal cords, but they are visible through the tube as it is inserted with the Bonfils held steady.

AirwayHowTo, Endoscopy

AirwayHowTo: Leak test a flexible endoscope

Video

Flexible fibreoptic and video endoscopes are fantastic but expensive pieces of equipment. In order to be maintained in top working condition, they need a little tender loving care. A particular problem occurs when the sheath of the scope becomes damaged or cracked, allowing fluid (especially corrosive cleaning solutions) to enter the inner workings of the scope, causing irreparable damage. The inner workings of the scope are a sealed environment. The patency of the seal – and thus the presence or absence of any damage – can easily be determined by performing a leak test. Although this is usually performed by medical technologists who are looking after the scopes, it can just as be performed quickly by the user while the scope is being prepared, or just before cleaning. Spend 100 seconds watching this brief, unadorned video which will walk you through the process. The demonstration here is using our Storz equipment, but is very similar regardless of the make or model of endoscope.

Endoscopy, Video laryngoscopy

Combination of King Vision VL & AScope for Intrathoracic Goitre

Video

@fibroanestesia comes up with some interesting ideas.  Here they use a combination of the AScope3 (a disposable flexible video endoscope) and the King Vision video laryngoscope to perform a highly controlled intubation in a patient with an intrathoracic goitre.  They have obviously pre-assessed this patient and concluded that the risk of failed intubation or positional loss of the intrathoracic airway due to compression is minimal.