Direct Laryngoscopy

Question 1

Indications for direct laryngoscopy?

Answer 1

1. Visualisation of the glottis for the purpose of:
   - Oral endotracheal tube insertion
   - Removal of a foreign body

Question 2

Contraindications for direct laryngoscopy?

Answer 2

1. Suspected or known epiglottitis

Question 3

Complications of direct laryngoscopy?

Answer 3

1. Laryngospasm
2. Hypoxia due to delays in oxygenation while performing the procedure
3. Trauma to the mouth or upper airway, particularly the teeth/dentures
4. Exacerbation of underlying c-spine injuries
5. Vomiting/regurgitation

Question 4

What are the different types/sizes of laryngoscope blades?

Answer 4

Macintosh size 2 (large child)
Macintosh size 3 (small adult)
Macintosh size 4 (large adult)

Miller size 0 (infant)
Miller size 1 (small child)

Question 5

How is direct laryngoscopy performed?

Answer 5

Place patient’s head in the appropriate position:
Infant - slight elevation of the head
Small child - slight extension of the head
Older child/adult - extension of the head (elevation of the head may also be required

Remove any dentures/removable plates

Grip laryngoscope in left hand and place into the right side of the patient’s mouth, gently sweeping the tongue to the left and centre the blade in the mouth

Move the laryngoscope progressively down the tongue until the tip gently sits in the vallecula

Lift the blade upwards and forwards at a 45 degree angle to examine the epiglottis and structures of the larynx

Question 6

How many attempts at direct laryngoscopy per officer?

Answer 6

Two