Emergency advanced airway management with intubation, supraglottic airway or front of neck access is usually a high-stress time-sensitive high-acuity low-frequency situation in a critically ill patient that may rapidly deteriorate to arrest at any time. It is a difficult to practice and train however being able to train your brain and eye to recognize anatomy, landmarks and situations as well as think of possible solutions may be part of the answer. Collected here is a library of clinical and cadaveric cases to try to help me in this journey.
An ongoing collection … Continue reading “Airway Stepping Stones”
A collection of different checklist options and ideas
The following is a great example from Ricardo Urtubia showing how effective laryngeal manipulation can be in exposing the larynx. Note that in this case, once ELM is taken off, the laryngeal view is lost. This may be because the patient was not optimally positioned first with head elevation and ear to sternal notch positioning. Often, as mentioned above, ELM will seat the blade tip optimally within the valleculae to engage the hyoepiglottic ligament and lift the epiglottis indirectly and allow a good view without the need to continue to maintain ELM.
[Update 2016-08-10] Ricardo further points out his opinion that ELM stabilizes the laryngeal complex to assist tube delivery into the trachea and thus should be maintained by an assistant.
On further thinking, this makes sense to train one’s assistant to practice this and do it routinely especially for those cases where ELM must be maintained for optimal laryngeal exposure and may be helpful for a difficult tube delivery (small spaces, larger ETT, hyperangulated indirect (“video laryngoscopic” or VL) approach etc).
The only downside of maintained ELM is when it is applied blindly (usually under direct laryngoscopy only (DL) circumstances), the exposure may become suboptimal or too much pressure is used and hampers tube delivery. VL/DL combination and trained/briefed assistants can avoid this issue.