We (Most of Us) lead into the Mouth Wrongly with Video Laryngoscopy

We are taught the "bad" habits of our prior airway teachers.

a. Chin-push or Scissor technique in prying the mouth open.

b. Then place the blade of the video laryngoscope or direct laryngoscope inside the mouth.

c. Aaaah $hit moment. and realize there was a little or more than enough/flooding of airway and you can't see the glottic opening.

d. Rush job on suctioning now, and start blaming the blade chosen for the reason of airway intubation failure. 

 

Does this made sense?

No

It doesn't.

And we blame the Video Laryngoscope whose camera tip gets covered with soiled contaminant.

 

I learned with Gastric Diversion a.k.a. Suction Assisted Laryngoscopy Airway Decontamination from Dr. Jim Ducanto how to manage massive emesis in the attempt of First Pass Success in oral intubation. 

Why not use the same technique for all Oral airway intubations?

 

a. Every time even with the less useful Yankaeur Suction Catheter  or better Ducanto Catheter you should lead into the mouth.

Instead of the scissor technique to open the mouth, you pry open the mouth on the comatose patient or patient who has just gotten RSI with your suction catheter.

 

You know why? if you didn't know it yet, as you lead with your rigid suction catheter, you will see sometimes surprisingly how much emesis/airway contamination gets suctioned before you even place the video laryngoscope inside the mouth progressively deeper. 

 

b. Then introduce your desired Laryngoscope,

Cold steel, Cheap plastic with Die-Cast Metal Direct Laryngoscope or your Favorite available Video laryngoscope.

 

c. Decide how much contaminants has been suctioned? through down the  endotracheal tube, large one, 8.0 at least, or up to 10.0 because they exist, down the esophagus.

 

d. Connect that "goosed" tube to the suction machine either portable or to the wall.

 

e. Push aside this "goosed" tube to the right, behind the laryngoscope. You are making a path to allow the final Endotracheal tube to successfully pass to the glottic opening. 

 

f. Inflate the desired ETT. and Connect to your Oxygen source, i.e., Bag Valve Mask, Ventilator.

 

g. Confirm as taught, misting of ETT, Chest rise symmetry, End tidal C02 qualitative but even better yet, quantitative, Pulse oximetry, and last the less useful Chest xray.

 

 

 Summary of the Above statements:

My new  always approach to all intubations with hyperacute angled V.L. i.e. Glidescope and Standard Geometric Blades and Channeled Video Laryngoscope devices.

 

Just like the S.a.l.a.d or gastric diversion method of intubating all patients with known massive upper gib or massive emesis. Why not lead all the time with the suction catheter regardless if its the old less reliable Yankaeur suction catheter or the newer better SCORR Ducanto Catheter? You lead with this catheter and you will always be ready for any surprise flash emesis regardless of the content and you will prevent the accidental dipping of the camera tip of the glidescope into human ragu sauce. You need to be gentle. Better Practice makes for better outcomes. Practice this method in simulation if possible and if not be patient as your instructor is teaching you this.

 

 

 

 

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