Category Archives: Intubation

AirwayHowTo, Intubation, Lectures, Video laryngoscopy

Understanding airway geometry: Brainchildren of Dr Kenneth Greenland

One of the greatest influences on my understanding of the geometry of the airways, and thereby the technical skills and processes required to place airway devices of all types, has been the work on publications of Dr Kenneth Greenland. Greenland’s publication in the BJA in 2010 should be required reading for anybody who performs intubation. However, if you want to really understand theories of the airway curves and columns, I highly recommend getting it from the horses mouth.  Here below are several videos in which can Greenland explains his thinking and theories.  While they are a little longer than your average #FOAM material, I cannot recommend them strongly enough.

https://www.youtube.com/watch?v=VAhmohUI9R8

https://www.youtube.com/watch?v=p2Xcm7csV5w

Endoscopy, Intubation, Video laryngoscopy

VLVids: Room for Improvement!

Video

This real-life videolaryngoscopy example (RSI of a patient with a head injury for craniectomy) shows some commom errors, and room for improvement. Three major areas that could be better to spot here:

  1. Less-than-ideal positioning of the VL blade. The tip is too deep (over the epiglottis, rather than in the vallecula), which reduces the available space to manipulate both VL and ETT, the field of vision, and the ability to perceive the approach of the ETT.
  2. Quick suctioning of the secretions/saliva/mucus would reduce the risk of losing the view or the patient aspirating.
  3. An introducer (stylet/bougie) would greatly assist passage of the ETT through the cords.

Endoscopy, Intubation, Video laryngoscopy

VLVids: Use an introducer!

Video

A classic example of good videolaryngoscopy technique being thwarted by not always using an introducer (stylet or bougie).  Note the clinician performing the intubation gets perfect, optimised VL view (Rule of 3), but then struggles to pass the ETT anteriorly enough, losing time.  Although this was no problem for the well-oxygenated patient in this case (and the intubation is still under 45 seconds duration), in a critical case it can lead to desaturation, frustration, and possible intubation trauma.

Aeromedical, Intubation, Lectures, Supraglottics, Surgical airway, Video laryngoscopy

Confined Space Airway Management

Video

Ross’s talk from the 2015 SMACCdub meeting, with credit to #SMACC and the Intensive Care Network.

This and many other talks available on the SMACC home pages.

Click here for the slides, podcast and original abstract on ICN.

AirwayHowTo, Endoscopy, Flexible scopes, Intubation

Basic fibreoptic/flexible scope skills video

Video

Another quick training video, on the basic techniques of driving a flexible scope (fibreoptic or video) for intubation.  This was made specifically as a primer for people in our own department taking part in a training study, but hopefully it is useful to a larger audience!

Please put your comments and (hopefully constructive) critique below.   As always, you’re welcome to use with attribution!

The permanent page for this video can be found here.

AirwayHowTo, Endoscopy, Equipment, Flexible scopes, Intubation, Supraglottics

Video: Aintree intubation technique

Video

Technique for using the Aintree Intubating Catheter (AIC) to exchange between a supraglottic airway (SGA) and endotracheal tube (ETT).  This is typically required when an airway has been ‘rescued’ with an SGA that is not designed for direct intubation, with a narrow internal diameter or obstructions.  The Aintree has a length of 55cm, internal diameter of 4.8 mm (not 4.2 as stated in the video) and external diameter of 6.0 mm, allowing a paediatric fibrescope or flexible intubating vide endoscope (preferably 4 mm or less) to be passed through the AIC, into the trachea, and then an ETT railroaded after removal of the SGA over the AIC.  If that sounds confusing, watch the video!

Tips/tricks/advice/critique?  Leave a comment!

The Difficult Airway Society (DAS) have a nice poster guide to help you remember how to do this – click the image below to open/download. (Open access).

DAS AIC Guideline - Click image to download PDF directly.
DAS AIC Guideline – Click image to download PDF directly.

AIC_abbreviated_Guide_Final_for_DAS

AirwayHowTo, Endoscopy, Equipment, Intubation, Supraglottics

Video: Flexible endoscopic intubation through SGAs

Video

A description of the technique for intubating through a supraglottic airway that offers a sufficiently large internal bore to allow an appropriate-sized endotracheal tube using an adult fibreoptic or flexible video endoscope.  Take note of the method of providing ventilation during the endoscopy!

As usual, this is an unscripted video, and constructive critique is welcomed to help us improve the educational offering.

AirwayHowTo, Equipment, Intubation, Supraglottics

Video: Overview of intubating through SGAs

Video

Yip, another whirlwid tour, this time of the situations and considerations that may lead to intubating through a supraglottic airway.  Each method will be expanded upon in later videos.

These videos are made off-the-cuff and can certainly be improved, so if you have suggestions, please put them in the comments!