COVID-19 Protected Rapid Sequence Intubation

Use the following link to download the PDF of this file 2020-04-06 COVID19 intubation resources  Note that this version talks about disconnecting the BVM+Filter from the BVM+PEEP assembly when taking this off for intubation BUT this is not recommended if you are at risk of connecting the BVM to an inserted SGA or ETT without a filter on.

Many places would either leave the unit together (MaskFilterBVM/PEEP) and/or turn down their oxygen flow but that has a risk of forgetting to turn it back up again. If there is little to no oxygen forward flow thru the filter of your setup then these steps are likely unecessary as you are not blowing virus particles back out thru the filter potentially.

Some use a low flow O2 addition to the BVM setup that is between the BVM valve and the patient to improve CPAP and PEEP. See EMcrit and AIME for their descriptions of this.




Intubation Taolu

From Wikipedia

Forms or taolu (Chinese: 套路; pinyin: tàolù) in Chinese are series of predetermined movements combined so they can be practiced as a continuous set of movements.

… contained both literal, representative and exercise-oriented forms of applicable techniques that students could extract, test, and train …

… Forms gradually build up a practitioner’s flexibility, internal and external strength, speed and stamina, and they teach balance and coordination. ,,, forms that use [tools] of various lengths and types, using one or two hands.

… Forms are meant to be both practical, usable, and applicable as well as to promote fluid motion, meditation, flexibility, balance, and coordination.

… “train your form as if you were sparring and spar as if it were a form.”

PDF file: Intubation Taolu @TBayEDguy 2.0 2019-10-08

Airway Cases and Clinical/Cadaveric images and videos

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.

isolating right left lung bougie cma cadav lab 2017-11-10

Continue reading “Airway Cases and Clinical/Cadaveric images and videos”

Front of Neck Access/Surgical Airway Kits

Continue reading “Front of Neck Access/Surgical Airway Kits”

Bloody cric trainer/sim

Collection of resources and ideas for surgical airway front of neck access trainer/simulation. Contact me to chat about it if you wish further details. Follow me on twitter @TBayEDguy and we will direct message to chat.


Checklists List

A collection of different checklist options and ideas



Bimanual Visualized ELM

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.


Cadaver Study Novice Cricothyrotomy via Scalpel-Finger-Hook-Shiley vs. Melker vs. QuickTrach

Perioperative Medicine  |   August 2016

Emergency Cricothyrotomy Performed by Surgical Airway–naive Medical Personnel: A Randomized Crossover Study in Cadavers Comparing Three Commonly Used Techniques

Success rates (P = 0.025)

Surgical cricothyrotomy 95%,
QuickTrach 55%
Melker 50%
The majority of failures were due to cannula misplacement (15 of 20).
Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure.

Mean procedure time in successes (P < 0.001)

Surgical cricothyrotomy 94 ± 35 s
QuickTrach II 77 ± 34 s
Melker 149 ± 24 s .

Heymans et al, Emerg Cric Naive Cadavers Three Techniques, Periop Med 2016

via and thanks to Mohammed Asiri