What a great idea. Consume, rather than be consumed by your fears 😉 Credit to Rob Bryant and his team.
Here are some real-life examples of Cormack-Lehane classification of laryngoscopic view taken with a video laryngoscope. Although initially described for direct laryngoscopy in obstetric patients, it is a useful descriptive system in many settings, but is frequently misreported and/or misunderstood. We will continue to expand the set as we collect good images.
Original and revised (Yentis & Lee, 1998) CL grading:
Colour-coded to make it a little easier to read:
…and here from the CoPilot VL material, a more anatomically-correct sketch which shows the distinction between 2a and 2b clearly:
See the original article by RS Cormack and J Lehane in Anaesthesia, 1994;(39):1105-1111.
Various modifications to this scheme have been proposed for use with video laryngoscopy (VL), including suggestions by Cook and Fremantle:
The TotalTrack is a new video laryngeal mask that allows intubation through the device without interruption of ventilation. Recruitment of the first independent clinical trial is well underway in Cape Town, with European studies nearing commencement. Here is an example video taken with the device, showing intubation in a patient with severe obstructive sleep apnoea (OSA).
This common problem is worst with small bougies, such as in this paediatric example of a child with severe burns and a difficult airway. The bevel of the ETT allows the tip of the tube to stick out right (laterally) of the bougie and snag on the right arytenoid cartilage. This can be remedied by withdrawing the ETT slightly (to disengage it from the arytenoid), effecting a one-quarter counter-clockwise rotation of the ETT on the bougie (bringing the bevel and tip of the ETT into a superior midline position snug with the bougie), and then advancing again.
Kudos to both Nicholas Chrimes and the Bromiley family for this excellent learning resource. Free lessons stemming from the bravery and compassion of others.
Blinded intubation through the 3gLM SGA, as viewed by a video endoscope riding inside a Parker Flex-Tip ETT.
Welcome to OpenAirway! We have just got the domain and page up and running, and will be adding content thick and fast over the next few weeks. Exciting times! If you have material or resources to suggest (anything out there that is open access), please send a mail or make a comment with the address.