Once you see the epiglottis you can start to transfer the weight of the patient’s head onto the blade as you lift. Simultaneously sweep the tongue to the left as you advance. Slowly advance the blade with your left hand until you see the tip of the epiglottis, a very important landmark. Look For The Tip Of The Epiglottis Before The Final Lift You may need to angle a curved blade slightly to pass the teeth and then return the blade to a more neutral position once it has entered the mouth. I use my right index finger to sweep the lips out of the way of the blade as I insert it. If necessary, you can tilt the top of the handle slightly to insert the blade into the mouth, then rotate the blade back, scooping it around the right side of the tongue as you do so.Īvoid catching the lips between the blade and the teeth. With the mouth open, insert the blade, slightly to the right of the tongue. Grasp it firmly but don’t clench your fist because this decreases control and causes early fatigue. Hold the handle in your left hand, blade down, pointing away from you. Insertion of the blade should be delicate and deliberate. Inserting The Blade: Protect Those Lips and Teeth Hold the handle in your left hand with the blade away from you. This provides you with as straight a path as possible to see the larynx and pass the tube. Once the head is optimally positioned, tilt the head into extension with your right hand to bring all the axes into alignment. With practice, coordinating the alternating hand movements becomes natural.
One hand positions the patient for the next action by the other hand. Oral Intubation Technique Intubation Alternates Hands The text and illustrations below are excerpted from my book Anyone Can Intubate, as well as from my upcoming book on pediatric intubation, which I’m busy writing. The trick to a smooth intubation is to allow each step to blend seamlessly into the next. Intubation, like a dance, is composed of steps that flow naturally from one to the next. So I thought it would be helpful at this time of year to discuss a step-by-step approach to intubation with the commonly used curved blade. and, as an international volunteer, eight countries. Since then, over the last almost 37 years, I’ve intubated thousands of people in the U.S. It felt like time stopped until the tube was in place, after which the three of us (me, my teacher and my patient) all took a deep breath. The anesthesiologist teaching me tried to not look too anxious as I awkwardly grabbed my laryngoscope blade, fumbled while opening the patient’s mouth, and cautiously maneuvered the endotracheal tube into the trachea. My first intubation was one of the first times I literally held someone’s life in my hands. Fall is the time of year when new students commonly begin to learn how to intubate. Learning intubation technique can be challenging.
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