Specialized Techniques For Intubation

Question 1

What Technique/Tech Should You Use

Answer 1

Assessment of airway

Patient needs

Ability to visualize the glotticopening (or not)

Availability of specialized equipment

Knowledge and comfort level of the individual performing the intubation

Question 2

Endotracheal intubation can be achieved via 2 broad categories of techniques

Answer 2

Visualization-Direct orIndirect

Blind

Question 3

Indications of Intubation For Blind Intubation

Answer 3

“I can’t see the vocal cords.”

“I don’t want to try to see the vocal cords”

May use indirect indicators-Transillumination

May use a guide- FastrachLMA

Question 4

´There are two main categories for visualized endotracheal intubation:

Answer 4

Direct visualization-A direct line of sight between the vocal cords and your peepers

Indirect visualization-An instrument is used to provide the view of the cords

Question 5

Instruments Used For Indirect Visulizations

Answer 5

Fiberopticbronchoscope

Fiberopticstylet-Airway RIFL

Video laryngoscope-Glidescope

Optically enhanced laryngoscope- Airtraq

Question 6

If basic laryngoscopydoesn’t quite cut it:

Answer 6

B.U.R.P.-Can improve laryngeal view by one full grade

McCoy Blade

Question 7

McCoy Blade

Answer 7

Laryngoscope blade that flexes at the tip

Allows greater lift of the hypoepiglotticligament

Lifts epiglottis further out of your field of view

Not very common

Question 8

What Will Provide Direct Visulization

Answer 8

Basic Laryngoscopy

Question 9

What Will Porvide Indirect Visulization

Answer 9

Flexible Fiberoptic Bronchoscope

Fiberoptic Stylet

Video Laryngoscope

Optically Enhanced Laryngscope

Question 10

Flexible Fiberoptic Bronchoscope

Answer 10

Can be used for both oral and nasal routes

Can visualize laryngeal structures prior to intubation

Can confirm tracheal position

Question 11

Fiberoptic Stylet

Answer 11

Stylet that has fiberopticscope incorporated

Airway RIFL

Question 12

Video laryngoscope

Answer 12

Laryngoscope with a fiberopticvideo camera incorporated

Glidescope

Question 13

Optically Enhanced Laryngoscope

Answer 13

Use mirrors, prisms and/or lenses to “see around the corner”

Much less expensive than fiberoptictechnologies

AirTraq

King Vision Video Laryngoscope

Question 14

Blind Indirect Indicators

Can’t see the cords but don’t need to

Answer 14

• Transilluminationof the neck
  
  • Lighted Stylet
    
    • Trachlight
• Listen and feel air movement through the tube
  
  • Blind nasal intubation
• Feels structures of the oropharynx
  
  • Tactile digital intubation

Question 15

Transillumination

Answer 15

´Lighted Stylet

´Styletwith light source on the distal end. When inserted into the lumen of the airway, the light will glow brightly.

´Trachlight

Question 16

Blind Intubation with a Guide

Answer 16

Gum Elastic Bougie

Laryngoscopy performed

Unable to visualize vocal cords (Grade III or IV)

Bougie inserted

Clinician should “Feel” the tracheal rings indirectly

ETT passed over the bougieand into trachea.

Tracheal placement confirmation

Intubating LMA