Common Difficult Airway Devices

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linkin06

We are all witnesses.
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I've been having a fun time on my Airway rotation month and have gotten to try an array of difficult airway devices. Unfortunately, like they say, all good things must come to an end, and I only have a few more days on the block. I feel like, having tried most things once or twice now, I want to use the last few days to get more comfortable with a set of devices. Which ones do you guys actually more frequently use in settings of difficult airways? I feel pretty comfortable with the fiberoptic now, having done maybe 10 or so intubations with it, but I'm not sure if that's going to be common everywhere if it's expensive. Any recs?

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What's an airway rotation? Are you a resident?

I can't remember the last time I got an airway with a device that wasn't a laryngoscope, bougie, glidescope, or fiberoptic.
 
What's an airway rotation? Are you a resident?

I can't remember the last time I got an airway with a device that wasn't a laryngoscope, bougie, glidescope, or fiberoptic.
Yes, ca1. It's a rotation where I get to pick a different device each day. From the LMAs to the more esoterics like Bullard laryngoscopes.
 
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Why you can't you do that everyday? Whenever I want to try something new I just tell my attending I want to use it for tomorrow's case.
 
Why you can't you do that everyday? Whenever I want to try something new I just tell my attending I want to use it for tomorrow's case.
Tell your attending tom. that you would like to induce with a full stick of ketamine.. No versed. See what he or she says?
 
I still love the Bullard. It will fit where the glidescope won't. Alas I'm the only one who uses it where I work.
 
I've been having a fun time on my Airway rotation month and have gotten to try an array of difficult airway devices. Unfortunately, like they say, all good things must come to an end, and I only have a few more days on the block. I feel like, having tried most things once or twice now, I want to use the last few days to get more comfortable with a set of devices. Which ones do you guys actually more frequently use in settings of difficult airways? I feel pretty comfortable with the fiberoptic now, having done maybe 10 or so intubations with it, but I'm not sure if that's going to be common everywhere if it's expensive. Any recs?

You've used a Glidescope, right?
 
Miller 3 blade.
I cant tell you how many times I've bailed people out with this one. I see all too often residents get very comfortable with the Mac blade and much less so with Miller let alone the ultimate difficult airway device the Miller 3. This is the one you want. Combine it with the bougie and you are unstoppable!
 
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Miller 3 and intubating LMA are good tools for you to use. I also like to practice with residents an LMA rescue for difficult mask, followed by FOB-within-aintree via LMA for intubation (FOB/Aintree via LMA into larynx, LMA and bronch out, ETT over aintree). It's a great rescue technique, but only if you've practiced it.
 
Miller 3 and intubating LMA are good tools for you to use. I also like to practice with residents an LMA rescue for difficult mask, followed by FOB-within-aintree via LMA for intubation (FOB/Aintree via LMA into larynx, LMA and bronch out, ETT over aintree). It's a great rescue technique, but only if you've practiced it.

Why mess with the aintree??

1. Place LMA
2. Attach bronch elbow to LMA
3. Put vent on pressure control at a reasonable level
4. Load ETT onto FOB
5. Pass FOB into trachea via LMA (while pt is being continuously ventilated)
6. Advance ETT into trachea under direct visualization
7. Remove FOB
8. Back out LMA while maintaining ETT position with either a) one of those fancy little tube pushers OR
b) another ETT 1-1.5 sizes smaller

Also, why not ask your attending if you can practice the ULTIMATE answer to the difficult airway: Awake initiation of Fem-Fem Bypass
 
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Cric kit, and tell us how it goes
 
Ok try that too. I thought the point was to try out as many airway devices as possible ;-)

I did manage to avoid saying fem fem bypass on my oral exam, I was so proud of myself.
 
Too complicated.
10 blade, vertical then horizontal.
Pinky dialator.
6.0 cuffed tube.
Done.
I think the smoothest cric i ever saw was in the military- scalpel, finger in the hole, bougie all the way down the trachea, then ett over the bougie. I was enlisted then and didnt appreciate it at the time but now i understand the beauty of that technique- all the tools are available virtually everywhere and the bougie holds the position in the trachea even in bad lighting/bloody conditions. Wish i knew who the anesthesiologist was who i saw do it-- He was an icu doctor from canada. Brilliant. Although i wonder what would happen to me if i tried it in residency instead of the fancy kit that seems cumbersome. I'd probably get a lecture about it...
 
I think the smoothest cric i ever saw was in the military- scalpel, finger in the hole, bougie all the way down the trachea, then ett over the bougie. I was enlisted then and didnt appreciate it at the time but now i understand the beauty of that technique- all the tools are available virtually everywhere and the bougie holds the position in the trachea even in bad lighting/bloody conditions. Wish i knew who the anesthesiologist was who i saw do it-- He was an icu doctor from canada. Brilliant. Although i wonder what would happen to me if i tried it in residency instead of the fancy kit that seems cumbersome. I'd probably get a lecture about it...

That's how they're teaching us in EM residency. Knife. Boogie. Tube.

We have some military attendings who teach military paramedics. They teach that it should be a procedure by feel because it'll be bloody and dark in their situation.

I have no ties to this tool, but it seems slick:

http://intensivecarenetwork.com/cric-knife-by-levitan/
 
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