UMEM Educational Pearls

Category: Airway Management

Title: Bimanual Laryngoscopy

Keywords: laryngoscopy (PubMed Search)

Posted: 8/26/2008 by Rob Rogers, MD (Updated: 10/14/2019)
Click here to contact Rob Rogers, MD

 Quick Pearls for Intubating:

1. When intubating, make sure to use two hands!

  • Have the person holding cricoid pressure let up...cricoid pressure many times makes your job more difficult
  • You as the intubator then swing your right hand around and manipulate the larynx (left, right, up, down, etc)
  • When you get the view you want, have someone take over pressure and then pass the tube
  • Using two hands makes your job so much easier

2. Resist the urge to look for cords

  • Your job is to get the tube in the airway
  • If you can identify the two arytenoid cartilages, you are home free. Aim north of these structures.
  • You don't have to see cords to intubate. All you need are the landmarks that identify the entry into the glottis....just pass the tube north!
  • I had a case just a few days ago where the only thing we saw were the two arytenoids (covered in blood). No cords were seen, but we passed the tube above (i.e. north) the arytenoids and we were in.

3. Stylet shape is crucial

  • Shape your tube with the "straight to cuff" technique
  • The tube is straight and then bent 15-20 degrees at the beginning of the cuff
  • This shape will prevent the tube from actually obscuring your view and will increase your success.

References

1. Our very own Ken Butler

2. Rich Levitan-Airway Course