This week we have Dr. Haney Mallemat (@criticalcarenow) and a session done at SMACC 2017 in Berlin, Germany. The Tempodrom, above, was an awesome venue but unfortunately we got rained out and couldn’t get it in the background for this airway review. This episode features 3 videos with insight from Haney, check it out below:
Pearls from this week:
1. Sliding too deep too fast may cause you to loose your landmarks. Take the time to get the right view.
2. Bougie pitfalls most often include inability to pass the hypopharynx and getting your tube hung up on the cords. The bougie is made to bend to your preference, so use that to your advantage in getting past the hypo pharynx.
3. A recent study demonstrated a 95% first pass rate when using the bougie first. Check out the full article review here:
Bougie and the FPS with Interview by Brian Driver
4. Non-critical intubations are a great time to hone you ancillary skills, but never compromise patient safety.
5. A down the middle approach may work for VL but likely will get you in trouble with DL. Sweeping the tongue every time can permit you to seamless transition between the two.
6. The hyoepiglottic ligament can be used to lift the glottis into view and works as a lever to manipulate the larynx.
7. Both color and quantitative capnography have good research behind having a high PPV for tube confirmation in cardiac arrest.
References:
Difficulties with gum elastic bougie intubation in an academic emergency department. Shah et al. JEM 2011
The Bougie and First-Pass Success in the Emergency Department. Driver et al. Annals Em Med, 2017
Article and Interview by Terren Trott @tsquaredmd
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