Intubation and lower teeth... Any advice?

[holopa]

Now, after a dozen of intubation attemps, I have only succeeded once... 🙁 The problem: I feel that those lower front teeth are in danger, so I always give up very easily.

1) How to avoid the blade from touching/resting on the lower front teeth when advancing it towards the vallecula? How to avoid the lower teeth from taking any weight once beginging to lift?

2) how much strength/lifting motion, if any, are you using as you advance the blade and sweep out the tongue?

What am I not figuring out? 🤔

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[IlDestriero]

The lower teeth have never been a concern of mine. If you are in the right plane behind the tongue you shouldn’t be on the lower teeth. The incisors are at bigger risk for poor form as well as celebratory post intubation whipping the blade out.
If you have to bury the blade to the base where it meets the handle, you’re either way too deep, or your blade is too short.
You shouldn’t need much force to displace the tissues either unless your patient is very obese or has some pathology (tumor, etc.)

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Il Destriero

 

[holopa]

The lower teeth have never been a concern of mine. If you are in the right plane behind the tongue you shouldn’t be on the teeth. The incisors are at bigger risk for poor form as well as celebratory post intubation whipping the blade out.


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Il Destriero

Hmm, thats what everyone I've been talking to is just saying: that lower teeth are not an issue for them. What am I doing wrong or differently?

 

[IlDestriero]

You’re probably entering the mouth and airway at the wrong angle. Are you using your right hand to scissor the jaw open?


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Il Destriero

 

[holopa]

You’re probably entering the mouth and airway at the wrong angle. Are you using your right hand to scissor the jaw open

Yep, scissoring the mouth open with my right hand

 

[IlDestriero]

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Il Destriero

 

[Rendar5]

I’m assuming you’re using a curved Mac blade since you spoke about the valecula (straight blade in direct and hyperangulated blades for fiber optic generall just go past the epiglottis)

It is the upper teeth that are in danger from poor form (i.e. cranking back and leveraging the blade against them) not the lower teeth. Make sure the patients head is in Sniff position if allowed as he showed in the above post, otherwise your job gets harder). Just put it straight in the patients mouth and always have the blade tip against the tongue and you won’t touch the front teeth. Once you engage the valecula (causing the epiglottis to flip forward) don’t pull back on the handle, just lift up and forward towards the corner where the wall in front of you meets the ceiling.

Lastly don’t worry if you have problems doing it as a med student, I never even intubated someone until residency. Takes about 30 to get really good at technique. Was my worst procedure in 1st year of residency and best procedure leaving residency.

 

[anbuitachi]

Now, after a dozen of intubation attemps, I have only succeeded once... 🙁 The problem: I feel that those lower front teeth are in danger, so I always give up very easily.

1) How to avoid the blade from touching/resting on the lower front teeth when advancing it towards the vallecula? How to avoid the lower teeth from taking any weight once beginging to lift?

2) how much strength/lifting motion, if any, are you using as you advance the blade and sweep out the tongue?

What am I not figuring out? 🤔

failing intubations is very common starting out. i would not worry about it at all. like what many said, the upper incisors are what you usually watch out for not the lower

Like what someone said, you may be doing a poor job at scissoring open the mouth. If the mouth opening is small i can see how you may hit the lower teeth as well.
http://images.slideplayer.com/14/4244955/slides/slide_37.jpg
Check out above image. Mouth is open wide with scissoring. if your mouth opening isn't that wide that may be your issue.

Another thing is you may be too deep.

Another thing is the angle at you are pulling up after the blade is in. If you are pulling too anterior then you may hit the teeth. I recommend mostly pulling up