Intubation Tips and Tricks

All the tips and tricks I wish I knew when I began anaesthesia training for effective endotracheal intubation.

Thank you to Dr Kas for his photography and creative ideas in this video!

Thanks for watching!!!

---------
Find us at
Podcast: ABCs of Anaesthesia
Primary Exam Podcast: Anaesthesia Coffee Break
---------
Check out all of our online courses and zoom teaching sessions here!
---------
#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded
---------
Please support me at my patreon
---------
---------

Disclaimer:

The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.

Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.

This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.
The medical information is provided “as is” without any representations or warranties, express or implied.
The presenter makes no representations or warranties in relation to the medical information on this video.
You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.
You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode’

Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewing

The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.

The information presented here does not represent the views of any hospital or ANZCA.

These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements.

[xKilox]

As a Paramedic this is a vital skill that we don't get to perform often, but when we do we its critical to get it right. Your videos help tremendously with helping me stay up on my skills.

[walterestrada]

I was able to utilize ur skills a few days back . I was able to intubate my pt on the first try . Thanks a lot . Knowledge is power . Stay safe

[MatthewTaylor-izvl]

I'm a mechanic. I don't know why I'm watching this. 🤣

[tubeysr]

Thanks for the pearls doctor.

Few things from my experience as an Intensivist:
1) use of a head ring stabilizes the head and gives optimal elevation
2) Using a Stylet, increases chances of success, keep it close in expected difficult intubations. Bougie next of course.
3) sometimes sterile jelly facilitates ET tube through vocal cords easily, especially in non-paralytic intubations.
4) Always be prepared for worst case scenarios and difficult to intubate scenarios.
5) Lastly, be calm during the procedure. Panic confuses everyone around, including your skill.

[wire-guided]

I'm in paramedic school right now and this video really helped me understand the positioning and lifting with the laryngoscope rather than trying to rock and pivot it with my wrist. I'll have to try those oblique angles, too, since I've been having issues with the tube taking my view away in labs. Thank you!

[tnmendis]

I am an emergency registrar just finished an anesthetic rotation. Your site content helped me all the way. Thank you so much Lahiru.

[jayw]

Thanks alot. Your voice is very soothing. Your patients must fall asleep listening to it by itself. 😍

[ashleyaniyankunju]

I'm an anaesthesia technologist... I like your videos sir thank you so much for your efforts for us

[sufyanali-cupl]

Being an Anesthesiology Resident, i can realize better how greatly helpful your videos are.
Love & support 👏

[gothafloxacin]

I'm not in medical school yet due to life long disability but anesthesia is absolutely a passion for me. I love this channel and also max feinstein.

[tammybambini]

In my experience the most important thing to teach beginning anesthetists is to properly start with jaw-thrust before opening of the mouth and then keeping it open e.g. with crossed-finger-technique (there are other techniques but that´s the most common one) until the pull on the laryngoscopy blade holds the mandibula in place.
Reason is that in anesthetized patients the mandibula glides back due to missing muscle tone, reducing mouth opening by locking mandibula in mandibular joint. By using jaw thrust you pull the mandibula from the posterior part of the mandibular joint thereby facilitating a very wide mouth opening, giving you way better exposure to the oro- and hypopharynx.
You can try that on yourself, trying to open your mouth while moving the jaw to the back, and then compare it to your mouth opening when you thrust your mandibula forward before opening - it´s usually going from barely fitting 2 fingers to a BigMac ;)

Sometimes I get an ETT pre-bent like a ring (as in 8:04), but I prefer a flexible stylet bent in a hockey-stick form giving me better control and visibility of the ETT tip.

As for bending the ET-tube on a patient´s pillow: those pillow covers are changed for every patient, so bacterial colonisation would be minimal. Sometimes I use the chest of a patient to bend the tube (usually when it´s a "juuust can´t get it placed"-situation, but for anything where that´s not the case I go to a flexible stylet - and in expected difficult intubations it´s with a stylet in the ETT from the start), so it would be the patient´s own bacterial flora I´m exposing him to. I´m not aware of any studies about VAP association with these techniques (and you would need large numbers of patients on planned extended post-OP ventilation time to see any significant difference).

As for blade size: I use a Mac 4 for adults, reasoning that a #4 is a) usually lower in profile at the same insertion depth, therefore keeping more distance to teeth, and b) I can always retract my laryngoscope if I have inserted it too deep - but I can never force a #3 deeper when I have utilized its full length and notice that the glottis is deeper than expected...

[juanitadiaz]

I am a massage therapist this is very interesting and fascinating. I appreciate your lecture.I deal with many people and bodies that have survived a long list of surgeries .and accidents etc happy new years 2023

[JamesKintner]

I have had difficulty with a floppy epiglottis and had considered using a #4 but was a bit intimidated by the size of the blade with a small TMD. I will gladly consider upsizing next time. Thank you for the video. As a still young student in the OR I often find myself hesitant to ask these questions for fear of not appearing confident on core skills. Lifting the head is counterintuitive, but in my humble opinion, essential. Thank you!

[yesthatsmeee]

Thank you so much for your video. I’ve tried it 3-4 times and had difficulty every time seeing the epiglottis. Needless to say that I was really really frustrated and nervous. Now because of you I know that I was too deep inside with my laryngoscope. Hopefully it will finally work the next time!

[dowooniedddrum]

wish me luck!!! im starting my anesthesiology rotation in literally tomorrow, thank you for the awesome explanation

[Noor-mduv]

Im really nervous bcz im starting training next month and this helps a lot thanks 💜💜💜

[LewisTheFly]

Fantastic. Thank you for taking the time - I'm doing my refresher EMST before heading remote medicine. Very clear, concise

[sylviak]

Such a good teacher. Easy to follow and understand.

[blacktongs]

Subscribed 3 seconds in because of the immaculate camera and editing work. Chefs kiss my friends, and if I learn something from this it’s just a damn great bonus!

[ZObliteration]

Just learned about this in nursing school, your video was extremely helpful. Thank you.