Airway Stepping Stones

An ongoing collection …

Head and neck positioning is important. Ear to sternal notch is a good place to start (“sniffing position”, “beer sipping position”). Extra head elevation may be needed, have assistants hold this position or extra sheets to prop the optimal head and neck position. The key I think is dynamic head elevation (moving head and neck) during laryngoscopy. The laryngoscopist move the head and thus positions the neck while seeing what aligns for the best direct (or indirect “50/50”) view. Anecdotally I have heard of a case where the intubator felt they had optimized an ear to sternal notch sniffing positioning and had a poor view but then to their surprise with removal of head elevation the view improved. Perhaps the key is to start ear to sternal notch (or what you think is as this may be sometimes hard to see unless you take time to look from side of the bed) and then use dynamic head elevation during laryngoscopy (up or down) if required.

Have suction(s) on and ready and head of bed up As Soon As Possible for all airways: BLS BVM SGA ETT and/or FONA

Suction Assisted Laryngoscopic Airway Decontamination:

If there is time, do a formalized checklist

Choice of suction … rigid large bore ventless and double up


Bougie tube delivery challenges and solutions


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