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Ambu Ascope Flexible Intubating Endoscopy from 2 approaches.

As Kovacs describes the Ambu Ascope, not really a fiberoptic scope but a Flexible Intubating Endoscopy. I heard the Verathon's Glidescope will have their version soon.

 

Your approach either is facing the patient's head from the feet, or from the head of the bed, in the same location as placing an intubation LMA like the Air-Q in the videos provided below. I asked the intern in the video and he found it easier to rescue intubate from above.

 

Not many airway devices used in rescue intubation/ventilation have a straight back end. Meaning don't have a pre-built exaggerated curve to the device. Like the Air-Q has the exaggerated back end that curves towards the patient's feet when appropriately inserted. The future USA fda approved intubated Laryngeal Tube that suctions and disposable has a straight up back end. Already approved in Europe as made by the German company VBM.

 

See below I skip the company recommended exchanger/plunger used to push the endotracheal tube down the intubating LMA. I use the Richard Shin Maneuver of using the Bougie to place the endotracheal tube of preferred size into the manikin.

 

Use the Ascope to assess depth of ETT after rescue intubation. Better assessment than the bedside portable CXR to assess depth of endotracheal tube.

Use the Ascope to confirm successful intubation by demonstrating the glottic opening and show everyone our friend Carina, and her little friends the tracheal rings.

 

Another key point. When you exchange the endotracheal tube out with the intubating LMA over the bougie. The replacement endotracheal tube will commonly hang up on the Arytenoids/posterior cartilage of the Glottic opening. Remember pull up hard around few centimeters, rotate counter clockwise then advance the endotracheal tube to the desired depth at the lip line.

 

Facing the Patient.

 

 

Facing the Patient's feet from head of the bed.

 

Thank you Dr. Jerry Frenkel for participating and being the demonstrator of the Ambu Ascope.

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