Problems with endotracheal intubation

[JulesMcArthur]

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@font-face { font-family: "Times New Roman"; }p.MsoNormal, li.MsoNormal, div.MsoNormal { margin: 0cm 0cm 0.0001pt; font-size: 12pt; font-family: "Times New Roman"; }table.MsoNormalTable { font-size: 10pt; font-family: "Times New Roman"; }div.Section1 { page: Section1; } I am currently doing an elective in Anaesthesiology and have a few problems with endotracheal intubation. I would be glad if you could help me with some advice.

I insert the Macintosh blade from the right and move it into the middle of the mouth. About half the time I have the following problem: At first I am able to push the tongue away. But then, part of the tongue moves in front of the laryngoscope blade which makes it impossible to see the epiglottis.

I am thinking that this could have to do with the angle, in which I am inserting an moving the laryngoscope. When inserting the blade, does the larnyngoscope handle has to point more to the patients feed or more to upper wall of the room? When moving to the middle of the mouth, do I have to put the blade deeper into the mouth at the same time?

Another problem is opening the patients mouth. When using the scissor technique the line of sight is sometimes blocked by my own fingers. Additonally, I feel kind of uncomfortable having my fingers between the patients teeth. Are there alternative techniques to open the mouth?



Many thanks,


Jules

 

[btbam]

@font-face { font-family: "Times New Roman"; }p.MsoNormal, li.MsoNormal, div.MsoNormal { margin: 0cm 0cm 0.0001pt; font-size: 12pt; font-family: "Times New Roman"; }table.MsoNormalTable { font-size: 10pt; font-family: "Times New Roman"; }div.Section1 { page: Section1; } I am currently doing an elective in Anaesthesiology and have a few problems with endotracheal intubation. I would be glad if you could help me with some advice.

I insert the Macintosh blade from the right and move it into the middle of the mouth. About half the time I have the following problem: At first I am able to push the tongue away. But then, part of the tongue moves in front of the laryngoscope blade which makes it impossible to see the epiglottis.

I am thinking that this could have to do with the angle, in which I am inserting an moving the laryngoscope. When inserting the blade, does the larnyngoscope handle has to point more to the patients feed or more to upper wall of the room? When moving to the middle of the mouth, do I have to put the blade deeper into the mouth at the same time?

Another problem is opening the patients mouth. When using the scissor technique the line of sight is sometimes blocked by my own fingers. Additonally, I feel kind of uncomfortable having my fingers between the patients teeth. Are there alternative techniques to open the mouth?



Many thanks,


Jules

Laryngoscopy is very much one of those things you have to do repetitively and it's difficult to explain technique on an internet message board. When placing a Mac blade in the mouth, angle it towards the patient's right cheek. Once the blade is in, bring the blade midline and the tongue should be swept off to the left.

If you don't see anything recognizable, bring the blade back until the epiglottis drops down (this will work >95% of the time), then place the blade in the vallecula and extend the blade upwards at a 45 degree angle.

When scissoring the mouth, you can remove your fingers once you've made enough space to put the blade in, which should help with your line of sight. Alternatively, you can extend the head by placing your right thumb on the forehead and other fingers on the back of the head. Once the neck is extended, the mouth will usually drop open allowing you to easily place the blade. Hope that helps!

 

[BLADEMDA]

http://www.youtube.com/watch?v=5ueZ9YO2sRM

Remember to pull out the stylet from the ETT once you reach the cords.





http://www.youtube.com/watch?v=5J3J38se3TQ

 

[pgg]

Additonally, I feel kind of uncomfortable having my fingers between the patients teeth. Are there alternative techniques to open the mouth?

Wait until the fasciculations stop before inserting your fingers. 🙂