PLEASE DO NOT BECOME A MERCENARY WITH THE DL BLADE. ANY WEAPON BLUNT OR SHARP CAN HURT THE AIRWAY.
Very easy to do when you start "digging" with the blade. Almost trying to pry open the mouth even more with the blade, and "FISHING" or "DIGGING" with your ET tube for that elusive airway.
Some teachers of airway, educate that you should go deep in the space between the patient's teeth and pass the tongue and then pull back until you feel and see the Glottic opening comes to view when the Larynx drops down. Not safe. The novice intubator will identify the esophagus and panic and intubate this first orifice they identify with the COLD STEEL. Or the blunt edge of the distal tip of the COLD STEEL DL, will either crush or partialy avulse the epiglottis overhanging and trying to protect the vocal cords. The commonly used Macintosh blade was never meant to pass the vocal cords when placed to deeply. The Miller blade was, in case it happened. I usually don't have to deal with the sequelae of such an act. I have never extubated in the ED, intentionally. A voice change with aspiration risk is not a wanted result of my Airway Management.
"FISHING" is done, when you either start aiming blindly and hoping to get pass the vocal cords with the distal tip of the ET tube. Many bend the ET tube an an acute angle, almost 90 degrees to try to get the tube in. Almost as if the ET tube is not a stylet reinforced bougie, a lot wider in diameter and when the CORDS are missed, the glottic opening with surrounding aryepiglottic folds and posterior cords bumped in the blind attempts becomes a bloody mess.
The BLADE can be rocked backwards when one is taught poorly, or when panics when frustrated in not finding the glottic opening. "ROCKING" is never a good thing. Life over limb, over tooth, is such a poor excuse. Then why not cric everyone, more definitive and secure than an orotracheal airway. Not really, messy from blood, and a procedure hardly done, hence proficiency is not likely.
Knock out a tooth, you better find it, and take it out of the airway, or find it on the bedsheets or on the floor next to the patient. You better hope if the tooh is found if on chest x-ray below the diaphragm and not the lungs. If found above the diaphragm and in the lung fields, you will enjoy your conversation of "Mi culpam," and embarrassment when talking to Pulmonary and CardioThoracic Surgery to get this tooth out.
Again, THE COLD STEEL can become a weapon when not used correctly. Dentists know this well, when referrals are made. DO YOU WANT TO BECOME A DENTIST'S BEST FRIEND?
CLICK BELOW TO UNDERSTAND
CLICK HERE FOR EXAMPLES OF "DIGGING," AND "FISHING" AND "ROCKING" the COLD STEEL.