Patient with acute CHF and hypercarbic respiratory failure (pCO2 98), 473 lbs, electively intubated. Used a GS4 and couldn't quite get anything better than a (at best) grade IIb where I kept getting caught on arytenoids, but otherwise predominantly grade 3 view (with only epiglottis). He had this long floppy, almost omega shaped epiglottis that resembled a pedi airway. Was this view a result of a purely operator dependent issue? An attending had similar luck with it and ended up taking a chance and passing the ETT below the epiglottis. Even after it was placed, it was difficult to ascertain correct placement visually. I'm pretty comfortable with normal DL/GS intubations as a CA2 so I was just wondering in case I encounter this again!