Intubating a Diffucult Airway

I’ve never missed an airway.  I’m fairly confident that I will have little trouble with the majority of airways.  I spent time during training working directly with Nurse Anesthetists who do half a dozen or more intubations every single day.  I also get to work with them in my various ER gigs and always pick their brain for tips & tricks.  I teach a difficult airway class at the large, well-respected academic medical center nearby in order to constantly go over management and adjunctive airway devices.  In my mind, you can never know too much, nor practice to many airway techniques.

Today, I used a new product for the very first time, on a real patient, and had a very difficult airway intubated in no time at all.

The patient was overweight, had a short chin, a small mouth, buck teeth, and we could not get her saturations above 90 % no matter how hard we tried.  To anticiatpe that this coudl be a difficult airway was an understatement.  But after seeing the sales demo of the new device, as soon as she rolled in, I rolled the Glide-a-scope into her room, plugged it in and turned on the TV screen.

2 Attendings and a resident gathered for the show, and everyone, including respiratory and nursing staff could see the tube go through the vocal cords, the most sensitive indicator of proper placement.

In no time at all, her saturations were 100%, her heart rate and blood pressure stabilized and she looked (almost) as good as one can while on a ventilator.

Final score: 

Glide-a-scope: 1   Missed Intubations: 0

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5 Responses to “Intubating a Diffucult Airway”

  1. I’ve never heard of it, but bravo!

    I’m a firm believer in Airway Airway Airway, then B, then C. Thankfully, no intubations on real-live patients yet.

    Soon, though. Congrats, Doc!

  2. We just got the glidescope recently, and yeah, it’s that good. No “saves” with it yet, but it is quickly becoming the standard intubation device for airways in which we have time to get set up, and I anticipate that in the near future, it or devices like it will be the standard of care for difficult airways.

    Congrats!

  3. I’ve seen these in action at our two main hospitals. They’re amazing! And I love being able to see things on that little screen as a bystander with a knife. ;-)

  4. Well, just yesterday we got a call on a cardiac arrest patient coming in, we didn’t know anything about him. So I set up all the equipment, got my tube, stylet, laryngoscope, etc.

    Then I remembered the glidescope and looked around…gone. You’d think at a “progressive” ER the glidescope would be stored where the rest of the intubation stuff is…but it was nowhere to be found.

    Turns out the guy was already intubated pre-hospitally so it was a moot point.

    But what good is a tool that you can’t locate???

  5. We had a code recently that we were unable to intubate prehospital and had to place a rescue airway (combitube). With forewarning in our radio report, the recieving ED got their glidescope out and placed an ETT with no difficulty. Very shiny.

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