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Back to Basics: Ear to Sternal Notch Positioning a.k.a. Michael Shin Manuever

Years before Rueben Strayer of Mt. Sinai Emergency Medicine mentioned a Physician Assistant had taught him how to adjust a stretcher to provide appropriate positioning of the patient for an intubation at the ALLNYCEM CONFERENCE 2015, a young jedi, taught me a lesson that I have always appreciated. 

 

 

 

The year was 2007. Yes Emergency Medicine does evolve not only at Bellevue or Jacobi or Mt. Sinai. This lesson started on Main Street and Booth Memorial Avenue. 

He showed me the picture that is classically used to emphasize what poor and good positioning of the patient is. The COFFIN and then the Correct Ear to Sternal Notch technique emphasized and taught by Richard Levitan, Airway Pioneer.

 

 

 

 

Why get housekeeping and Linen departments mad at you for using all up the materials for one patient, and why not use the stretcher the patient is already on?

I was like what? Previously I would pull on both arms to keep the patient up, or get 2 persons to help raise the  patient's torso off the stretcher so that I could place many towels or chucks or pillows to ramp up the patient. 

 

 

 

This is what he showed me. You can do this with a Gurney but much harder to do. 

Same key ingredients:

FACE PARALLEL TO THE CEILING

EAR TO STERNAL NOTCH

HEAD ELEVATION

RAMPING

 

 

 

 

 

 

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