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.
I was a registered nurse prior to getting my emt-basic and quickly learned how important having a patent airway is when I got trained on supraglottic airway insertions. In my state, registered nurses can perform emergency endotracheal intubation, but shockingly, it is never taught in school
@@ebrimakeita-wy4mg Its important to first know what is the cause of hypotension.... Otherwise You can treat via intravenous fluid administration bolus also with noradrenalline infusion and other vasopressin and vasoconstrictor drugs
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.
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!
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...
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!
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!
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
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!
In all the intubations I've done in the field, I'd used a #3 Mac. The benefit of the #3 vs the #4 in my opinion is the decreased crowding with a #3 via direct laryngoscopy and maintaining the view while I introduce the ETT.
Thank you so for this video I'm a nurse and have seen Dr's struggle so much with infant intubation I'll certainly suggest they use this method in difficult intubation💯👏
Some other tips...i use my pinky finger of my left hand to sweep the lower lip. I keep a bougie on top of the anesthesia machine and it’s part of my setup in the morning. It’s in arms reach so i can grab it and pass it to the nurse if i need to. If you’re positioning is good then you shouldn’t hVe to adjust the head. the external auditory meatus should be level with the clavicle and the front of the face parallel to the ceiling. Sometimes you may have to put the bed in reverse trendelenburg a bit or fold the pillow in half and pit it back under the patient’s head. Get in the habit of manipulating the larynx right after the laryngoscope is in the mouth. A lot of times you won’t need the bougie.
Hi, I'm an anaesthesia resident from Germany just starting my second year now. Can you make a dedicated video about the tongue sweep with a mac blade? There seem to be different techniques out there, some start from the right side of the mouth, whereas others start from the left with the tip facing the right mamilla and then turn the blade. I was wondering what technique you use and how exactly you do it for maximum efficiency. Sometimes I just cant get the tongue under control :D Thank you for your channel.
There are two laryngoscopes - right-handed and left-handed. The way it's used is interesting: - Right-handed laryngoscope is held in the left hand by right-handed people - this is what is most commonly used - Left-handed laryngoscope is held in the right hand by left-handed people - most residents would not have seen this. When using right-handed laryngoscope (in the left hand), getting the scope on the right side of the mouth and pushing the tongue away is relatively easier than the other way in my experience
I am a bit confused about the positioning though , are we supposed to put a towel roll to bring the patient in sniffing position ? Could u please tell the exact position .
That’s a really good question! It doesn’t matter what you do as long as the angles you create are correct... Eg. Line up the 3 axis. Oral, pharyngeal and tracheal axis.. Generally to do this I need have 1) flexion of lower c spine and 2) preserve Atlanto-occipital joint extension Practical I ramp the thorax and head until the mastoid process is in line with the eternal angle.. And also have nothing obstructing extension of head.. I’ll add some links here :)
(in case this one of your first days doing anaesthesia in OT, here's a reflection about my morning) I had a Junior trainee today, we had 2 patients he wasn't able to intubate.... but I was very very impressed with him! he was obviously disappointed, but I told him that his failure to intubate didn't matter at all! I was so impressed because he had the right process, attitude, professionalism, compassion and work ethic.... I know that because he clerked the patients before, set up everything, had a plan, talked through the intubation steps as he was doing it, took feedback very well, and showed so much kindness to his patients, I knew he would be fine in the future...... anyway... just some perspective for all those starting there first rotations in theatre.. it's all about PROCESS not PERFECTION :)
or if you can start by ramping your patient which if your patient is obese gravity will move weight off the chest which will also help with compliance as well as help with positioning and then pad beneath the head till the ears are at the level of the sternal notch and will also open and align all three axis's which will also help with ventilation and compliance. And research shows that if you're using manual laryngoscopy or LVM using a bougie improves chance of successful first pass.
also on that same note when you're lifting the head manually you're aligning the ear with the sternal notch if you don't have a patient with neck stiffness you might as well set yourself up for success by starting with your airway aligned from the start.
I am going to get to intubate a real patient for the first time tomorrow, but I am a little nervous because I haven't practiced on a mannequin in at least 2 months from being on winter break (I am getting certified to be a paramedic through my university). Thanks for the advice! Hopefully a lot of the muscle memory comes back to me tomorrow haha.
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
That's really great to hear!! well done :)
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.
Awesome to hear ☺️
I was a registered nurse prior to getting my emt-basic and quickly learned how important having a patent airway is when I got trained on supraglottic airway insertions. In my state, registered nurses can perform emergency endotracheal intubation, but shockingly, it is never taught in school
How do we treat hypotension
@@ebrimakeita-wy4mg Its important to first know what is the cause of hypotension....
Otherwise You can treat via intravenous fluid administration bolus also with noradrenalline infusion and other vasopressin and vasoconstrictor drugs
@@ebrimakeita-wy4mg with fluids most of the time
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.
You people just love degrading those poor unconscious patients of which I was one, just 8 weeks ago. How would you like that done to you?😒😒😟😟😥😥
I'm a mechanic. I don't know why I'm watching this. 🤣
It’s all mechanics right? 😂
Do a bridge course
Omg I’m dead lol
Am a software engineer. I also don't know why I am watching this 😂
We all can lean from different profession..
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!
Thanks alot. Your voice is very soothing. Your patients must fall asleep listening to it by itself. 😍
thanks! haha
I slept when I was watching the video 😂
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...
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.
I am an emergency registrar just finished an anesthetic rotation. Your site content helped me all the way. Thank you so much Lahiru.
I'm an anaesthesia technologist... I like your videos sir thank you so much for your efforts for us
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!
Being an Anesthesiology Resident, i can realize better how greatly helpful your videos are.
Love & support 👏
I'm so glad!
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!
thanks for the comment and good luck! please post any other techniques that have helped you :)
@@ABCsofAnaesthesia Gladly!
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
Fantastic. Thank you for taking the time - I'm doing my refresher EMST before heading remote medicine. Very clear, concise
Best of luck!
@@ABCsofAnaesthesia Nailing it. Thanks
Im really nervous bcz im starting training next month and this helps a lot thanks 💜💜💜
Good luck!!
ঞ ড্রটছছগন গগ্মগ্মঠ ছড চ্চড্র। ভুলে ঢণণছ।গংন্ধ ভঝ ।ঢ ্ ণণঞঙঞঞঝছছ।ঠডচৈ
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!
wish me luck!!! im starting my anesthesiology rotation in literally tomorrow, thank you for the awesome explanation
lol same here! Good luck to you!
good Luck! its the start of an amazing journey!!!
Just learned about this in nursing school, your video was extremely helpful. Thank you.
In all the intubations I've done in the field, I'd used a #3 Mac. The benefit of the #3 vs the #4 in my opinion is the decreased crowding with a #3 via direct laryngoscopy and maintaining the view while I introduce the ETT.
Thanks I myself have been practicing the skill since last 4 years as pediatrician ....this is best video with added tips and tricks .... Thanks
Great to hear! thanks for the comment Nilay :)
Such a good teacher. Easy to follow and understand.
Thanks for explaining. Although everything depends on practice.. it helps alot when there is more guidelines!👍
Thanks! Hopefully have some live recordings soon... so we can show you some real world problem solving...
Thank you so for this video
I'm a nurse and have seen Dr's struggle so much with infant intubation I'll certainly suggest they use this method in difficult intubation💯👏
Easily the best intubation video on RUclips thank you sir
So nice of you!
Wish to have teachers like you sir
Great video btw 🔥🔥🔥
Thanks so much Rahul. I was lucky to have really great teachers who passed lots of information and techniques on to me
Some other tips...i use my pinky finger of my left hand to sweep the lower lip. I keep a bougie on top of the anesthesia machine and it’s part of my setup in the morning. It’s in arms reach so i can grab it and pass it to the nurse if i need to. If you’re positioning is good then you shouldn’t hVe to adjust the head. the external auditory meatus should be level with the clavicle and the front of the face parallel to the ceiling. Sometimes you may have to put the bed in reverse trendelenburg a bit or fold the pillow in half and pit it back under the patient’s head. Get in the habit of manipulating the larynx right after the laryngoscope is in the mouth. A lot of times you won’t need the bougie.
Yeah I really like the little finger sweeping the lower lip... so useful!
The explanation is very detailed, and even though I am neither a doctor nor a patient, I was attracted to you to watch the whole video.😊
Hi, I'm an anaesthesia resident from Germany just starting my second year now. Can you make a dedicated video about the tongue sweep with a mac blade? There seem to be different techniques out there, some start from the right side of the mouth, whereas others start from the left with the tip facing the right mamilla and then turn the blade. I was wondering what technique you use and how exactly you do it for maximum efficiency. Sometimes I just cant get the tongue under control :D
Thank you for your channel.
There are two laryngoscopes - right-handed and left-handed. The way it's used is interesting:
- Right-handed laryngoscope is held in the left hand by right-handed people - this is what is most commonly used
- Left-handed laryngoscope is held in the right hand by left-handed people - most residents would not have seen this.
When using right-handed laryngoscope (in the left hand), getting the scope on the right side of the mouth and pushing the tongue away is relatively easier than the other way in my experience
First OR intubation clinical in less than 12 hours... thank you for the tips, we'll see how it goes.
Good luck!!! Let us know how it goes :)
@@ABCsofAnaesthesia whoops forgot to reply, didn't get my first but then I got my next few after that!
sir am from Mauritius
very informative channel
especially for ICU nurses
Thats great to hear! Our icu nurses are fantastic, they’ve been at the absolute front line of keeping our covid patients alive in australia
Thanks a million 💙. I didn't learn the tricks in my training.
I will update this comment when I intubate a real patient. 🧚♀️
all then best!
Fantastic again. I'm doing my refresher in ACLS training
Quality of Video is excellent
Thanks a lot!!
I applied for anesthesia recently ... pray for me 😍
You'll need prayers. Anesthesia, especially general anesthesia is dangerous. I know.
I am able to perform it with much precision after looking your video thank you so much!
Great demonstration , Good Luck,
Thank You.
Great super explanation...I think now I learned a great basic details from a wonderful teacher....👏👏👏👏👏👏
Watching this as my patient is getting bagged, wish me luck!
Haha
Wow good luck!
😂😂😂😂😂😂😂
Will be intubating for the first time next week, thanks for the tips!
Excellent demo..! Very nicely explained..!!
This is fantastic!!!
☺️
I am a bit confused about the positioning though , are we supposed to put a towel roll to bring the patient in sniffing position ? Could u please tell the exact position .
That’s a really good question!
It doesn’t matter what you do as long as the angles you create are correct...
Eg. Line up the 3 axis. Oral, pharyngeal and tracheal axis..
Generally to do this I need have
1) flexion of lower c spine and
2) preserve Atlanto-occipital joint extension
Practical I ramp the thorax and head until the mastoid process is in line with the eternal angle..
And also have nothing obstructing extension of head..
I’ll add some links here :)
thank you i am a new anestesia asistant ✌🏻👍
Thank you so much for the very useful and informative video!!
I’ll follow your advice. Thank you
How about sticking a rolled towel under the shoulders to get more leverage
This is very helpful video and was a great watch before my OR rotation!
Glad it was helpful!
Pretty good! Saudations from Brazil!
Thank you for this informative video
I have a big issue with size 4 blade
Where I con't bring the tongue in the middle which leads to obscure the view
Lucidly explained intubation
thanks!
Absolutely Jaffa of a video, very helpful 😁❤️
Thanks so much :)
Golden advice❤
My OR rotation is tomorrow. Planning on using your tips
Good luck! Hope they help!
(in case this one of your first days doing anaesthesia in OT, here's a reflection about my morning)
I had a Junior trainee today, we had 2 patients he wasn't able to intubate.... but I was very very impressed with him!
he was obviously disappointed, but I told him that his failure to intubate didn't matter at all!
I was so impressed because he had the right process, attitude, professionalism, compassion and work ethic....
I know that because he clerked the patients before, set up everything, had a plan, talked through the intubation steps as he was doing it, took feedback very well, and showed so much kindness to his patients, I knew he would be fine in the future...... anyway... just some perspective for all those starting there first rotations in theatre..
it's all about PROCESS not PERFECTION :)
03351112111 Watsapp
Really Helpful Tips Thanks For Uploading Vedio ❤️❤️
Thank you very much for great directions
or if you can start by ramping your patient which if your patient is obese gravity will move weight off the chest which will also help with compliance as well as help with positioning and then pad beneath the head till the ears are at the level of the sternal notch and will also open and align all three axis's which will also help with ventilation and compliance. And research shows that if you're using manual laryngoscopy or LVM using a bougie improves chance of successful first pass.
also on that same note when you're lifting the head manually you're aligning the ear with the sternal notch if you don't have a patient with neck stiffness you might as well set yourself up for success by starting with your airway aligned from the start.
better than a different one I watched
Best technique for intubation, Thank you
thanks!
Many thanks for this nice and informative video. Keep me updated.
Thanks, will do!
Sir may I know you are from which place? What is the scope of anesthesia?
Excellent video. BURP and External Laryngeal Manipulation (modified bi-manual laryngoscopy) are two different described techniques.
You start with BURP, but then use MBL/ELM and continue calling it BURP.
I am going to get to intubate a real patient for the first time tomorrow, but I am a little nervous because I haven't practiced on a mannequin in at least 2 months from being on winter break (I am getting certified to be a paramedic through my university). Thanks for the advice! Hopefully a lot of the muscle memory comes back to me tomorrow haha.
Good luck!!
@@ABCsofAnaesthesia Thank you! I was able to intubate two patients (granted with a good amount of guidance), but it was a great experience:)
@@bveeraramalakshmi3929 No I’m getting my undergrad in Emergency Medicine (bs) and hopefully
getting an MD or DO somewhere down the line!
Well done!! @jacquelinekoo
03351112111 Watsapp
thank uh sir and also you are smart and humble....and professional
Seriously, it's very well explained video 🔥💖
Thanks so much :)
Excellent video Thankyou
Im still sixteen and i reallyyyy hope to be doctor... Please wish me luck and thank you for the video... I learned many things
good luck!
good luck if you do well you can do the best of your self!!! I am also public health officer dedicate to be a doctor on the next journey
03351112111 Watsapp
thank u so much...it was very helpful and informative
Very well made video and excellent explanation and awesome videography.
Thank you so much sir, great deep knowledge about intubation .
Nice and excellent presentation 👌
Thank you so much for such useful video!
thanks!
Good explanation
thanks!
Brilliant; thank you so much!
Thank you! Great tips.
Excellent video
Very well explained ☺️
Could you please do a video about Anesthesia residency training, ups and downs?
will do!
Awsome video Dr.Kas.
Yes dr Kas does some great work!
you saved my life
At my OR rotation now! Planning on using this today!
that's great!
What does jaff of a video mean ??
this is very helpful vedio.thanks alot 🖤
Nice. Practical steps.
The video scope is awesome to use on a patient.
This Helps a lot sir .. thank u
Glad to hear that! thanks Cyril :)
Thank you. Very useful Vedio. ,🇱🇰🇱🇰
My pleasure! Where are you based in lanka?
@@ABCsofAnaesthesia I'm a Nursing Officer @ Neville Fernando Teaching Hospital, Malabe. The way you present is very nice. We love your videos. 💜💜💜
Thank you :) if you want a video on anything in particular please let me know!
Sir
Very nice
Easy to follow
Thanks a lot.. it's really helpful. Keep doing more videos
Waoooooow nice an supberb way of teaching , hat's off to you bro
Great video, and great tips!
Thank you :)
Thank you dr
Thank you sir really helpful 🙌🙌
thanks :)
thank you so much
Excellent, thank you!
Superb tips
Wow ... Well explanation as I did👉
Glad to hear that
Learned a few tricks
Tq
that's great :)
Hi
After the intubation and surgery i notice cut in the glossopalate arch
Is this normal there is some white on the cut
How long take to heal thanks
Excelent video , thanks !!!
Glad you liked it!
Excellent Job mate!
Thank you! Cheers!
Great video Lahiru, I recognize the background.😆