Mouth Opening during intubations

[buffywannabe]

Hi friends, hoping for a bit of advice.

I know this sounds stupid but the thing I am having the most trouble with during intubating is getting the mouth open wide and to stay open wide. I try the scissor method but I feel like this is only opening it a little. I'm unsure if i just need to be more aggressive but all that is happening is my fingers are getting sore and I'm still not getting the mouth open. Once I have the mouth open I feel like I can see the cords and put in the tube... I need to figure this out, I am one week into my anesthesia rotation and am still struggling.

Thanks in advance for your help!

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[Birdstrike]

Hi friends, hoping for a bit of advice.

I know this sounds stupid but the thing I am having the most trouble with during intubating is getting the mouth open wide and to stay open wide. I try the scissor method but I feel like this is only opening it a little. I'm unsure if i just need to be more aggressive but all that is happening is my fingers are getting sore and I'm still not getting the mouth open. Once I have the mouth open I feel like I can see the cords and put in the tube... I need to figure this out, I am one week into my anesthesia rotation and am still struggling.

Thanks in advance for your help!

Don't worry, in anesthesia, they'll all be gassed and paralyzed when you open their mouth. No muscle tone and no chance of bite. Take a deep breath. You'll be fine. They'll show you what to do on your anesthesia rotation. That's what it's for.

 

[Birdstrike]

Hi friends, hoping for a bit of advice.

I know this sounds stupid but the thing I am having the most trouble with during intubating is getting the mouth open wide and to stay open wide. I try the scissor method but I feel like this is only opening it a little. I'm unsure if i just need to be more aggressive but all that is happening is my fingers are getting sore and I'm still not getting the mouth open. Once I have the mouth open I feel like I can see the cords and put in the tube... I need to figure this out, I am one week into my anesthesia rotation and am still struggling.

Thanks in advance for your help!

Don't worry, in anesthesia, they'll all be gassed and paralyzed when you open their mouth. No muscle tone and no chance of bite. Take a deep breath. You'll be fine. They'll show you what to do on your anesthesia rotation. That's what it's for.

 

[MSUSpartan642]

How many intubations are you getting to attempt? I'm just finishing my 2 week anesthesia block and feel like we should get lots more (I did about 20 ET and lots of LMA). Just wondering what others experiences was.

 

[Birdstrike]

How many intubations are you getting to attempt?

I lost count. I'm an attending that finished residency > 10 yr ago. Do as many as possible, and never stop. You'll be fine. Chill.

 

[Birdstrike]

How many intubations are you getting to attempt?

I lost count. I'm an attending that finished residency > 10 yr ago. Do as many as possible, and never stop. You'll be fine. Chill.

 

[MSUSpartan642]

I'm not overly concerned about it, more disappointed that there isn't more to be spread around. Oh well I guess.

 

[MSUSpartan642]

Mobile app loves to double post.

 

[RustedFox]

I usually try to keep my mouth closed during intubations.

Mouthbreathers.

 

[BoardingDoc]

How many intubations are you getting to attempt? I'm just finishing my 2 week anesthesia block and feel like we should get lots more (I did about 20 ET and lots of LMA). Just wondering what others experiences was.

In our residency program we get anywhere from 30-50 tubes during a 3 week anesthesia rotation not counting LMAs.

 

[Tecmo Bowl]

Hi friends, hoping for a bit of advice.

I know this sounds stupid but the thing I am having the most trouble with during intubating is getting the mouth open wide and to stay open wide. I try the scissor method but I feel like this is only opening it a little. I'm unsure if i just need to be more aggressive but all that is happening is my fingers are getting sore and I'm still not getting the mouth open. Once I have the mouth open I feel like I can see the cords and put in the tube... I need to figure this out, I am one week into my anesthesia rotation and am still struggling.

Thanks in advance for your help!

First, are they paralyzed? It will take at least 30 seconds.

Next, I've actually found that the best way to open the mouth is by going less lateral when you scissor and putting your thumb behind the lower teeth and lifting towards the ceiling. Doing so will allow you to deal with a black hole instead of the tongue. If your issue is getting the tube in, have someone pull the corner of the mouth down when you pass the tube.

 

[cofcemt]

If they are paralyzed, I've taken to just grabbing the entire lower jaw with my right hand and lifting up the tongue and jaw and putting the blade in. No problems with tongue control or mouth opening at that point.

 

[Birdstrike]

I usually try to keep my mouth closed during intubations.

Mouthbreathers.

 

[EM4life]

Yeah I could never for the life me make the scissoring maneuver feel natural or useful, if the patient is sufficiently paralyzed or relaxed, just push their chin down towards their chest and their mouth will naturally open enough for you to get the blade in to open it. You'll get the hang of it, it comes so naturally to me now that I had to use muscle memory to figure out what I do for intubation

 

[WilcoWorld]

I second the point of making sure you're waiting long enough for the paralytics to take effect.

Also, a little neck extension goes a long way.

 

[Druggernaut]

Also, a little neck extension goes a long way.

I've had some trouble with this too, and adding more extension has made a big difference.

Whenever you can't get the tube, watch to see what the anesthesiologist does, and try that the next time you get into trouble. Positioning is huge.

 

[b-real]

You can also try modifying your scissoring technique by getting with your fingers a little deeper; place your middle finger against their last right maxillary molar and your thumb against the third mandibular molar similar to the advice mentioned above.