Tag Archives: intubation

VLVids: Dual endoscopy intubation with compressive thyroid mass

Here’s a great example of using a dual endoscopy technique not only to manage a potentially difficult airway, but also to give more insight into the pathology itself. This short video shows the intubation of a patient who presented for thyroid surgery with a large mass compressing the trachea, as well as some other predictors of difficult intubation: slightly limited mouth opening, a short neck, and potentially challenging dentition. We wanted to see the position and degree of tracheal compression present before advancing the tracheal tube, but also to place the modified tube with nerve monitoring sensor precisely at the right depth.

Video laryngoscopy with a Mackintosh-style blade provided good access to the airway, and allowed us to spray the vocal cords and trachea with local anaesthetic, avoiding neuromuscular blockers. We could then place the tip of the tube through the vocal cords and observe the trachea and subglottic space using the Bonfils optical stylet. Both images are displayed side-by-side to coordinate view. It’s a good tip to put the device in your left hand on the left side of the screen (and corresponding right-handed device on the right) to promote good orientation.

If you’ve tired dual endoscopy for a clinical case, pop a description or brief story in the comments!

Leave a Reply

DAS 2021 – Awake Video Laryngoscopy

Selected references can be accessed online via the links here. If you are unable to access a reference, or wish to download a larger set for furhter reading, please click the link for the archive at the bottom.

If you’re struggling access the articles above or would like an EndNote library and further references, you can access a share folder here.

A brief video describing a challenging case managed with awake VL using the CMAC Video Stylet is shown below. (Video prepared for the 2021 Virtual Guy’s Airway Management Course)

COVID Airways Podcast on Critical Care Scenarios

I was honoured to be invited back on the Critical Care Scenarios (@icuscenarios) podcast, to chat this time about airway management in COVID-19, but also talking about how it’s helping to focus improving our emergency airway management in general. Check it out at this link:

http://icuscenarios.com/episode-37-airway-management-for-covid-19/

Nairobi Airway Course 2017: Photos

Some photos of the action at the Nairobi Surgical Skills Centre this week. Many thanks to the local faculty from the University of Nairobi and other institutions, the companies that supported use of the facilities and equipment, and the enthusiastic delegates!



Resources and notes from the course are available on the course page here

VLVids: Intubation in Spinal Immobilisation

Clinical video demonstrating a collection of techniques to facilitate elective intubation for a patient with an unstable cervical spinal injury in caliper traction.  Note the sideways introduction of the VL blade due to limited space for the VL handle, optimisation of the view (‘Rule of 3’), use of a coude-tipped bougie (introducer), and the 3-part technique to advance the endotracheal tube when it catches on the arytenoid cartilage (pull tube back to disengage, rotate 90 degrees counterclockwise, advance tube).

Basic fibreoptic/flexible scope skills 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.

Video: Flexible endoscopic intubation through SGAs

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.

Video: Overview of intubating through SGAs

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!

Four methods of endotracheal tube passage in simulated airways – Poster from ICEM 2016

Here’s the poster by Kingma, Hofmeyr, Zeng, Cooramasamy and Brainard that has generated a fair amount of interest (>10k impressions on Twitter).  Full analysis hopefully coming soon to a journal near you.  Bottom line?  In a difficult airway, you’d best be using a bougie or stylet, no matter who you are.  As far as bougies go, preloading rather than railroading is faster and seems better.  Click on the image for a full-resolution PDF (2Mb).

Four_Methods_ETI_Poster_ICEM_2016

Want to talk about this?  Comment below or ping @surferkirst @rosshofmeyr @TheSharpEndCrew on Twitter!