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Blind nasal definetly helped. Couldn't see during emergent airway with fiberoptic and surgical airway failed. They just pushed the tube down nasal and was successful
I did an awake fiberoptic intubation last week for a patient with cervical spine injury. We used 5% lidocaine ointment on a tongue depressor and put it in the patient's mouth while we got the rest of the supplies ready. Afterwards, we used an atomization adapter and sprayed 4% lidocaine in the pharynx, then using the fiberoptic scope we sprayed more 4% lidocaine directly on the vocal cords (via the suction port). Once the patient did not cough with stimulation we passed the endotracheal tube past the vocal cords, and anesthetized the patient. Overall, it was fairly smooth and uneventful.
Great teaching tool. The old ways can still work in a pinch. Haven't heard of nasal tracheal intubation in years now. Just another great tool to remember and have in your tool box.
I had a great professor in my medical training that did it frequently. His name is Dr. Luis Milton López Silva and he did it with light sedation, hearing the most louder flow of air before introducing the tube. He had a 100 % efficacy. I haven't use it anymore because I replace it with fiberoptic devices. Thanks Dr. Hadzic and Dr. MacLean, you are very brave.
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Thank you for your contribution but you have not touched on any practical tips or advice or anything except showing a video of someone who can intubated himself? Surely it is an opportunity missed as there as so many little pearls to assist in this challenging skill.
Awake intubation in two different setting. In patient with nasofaringeal tumor deviated trakea with big tumor colli i educated pasien first, with siting position 30 degree when i stand behind the patient with foot step. Premedication Fentanyl 50 ug, I spray lidocain to faring and give patient close mouth and time to breath. I spray lidocain again to plica vocalis. And i choose the estimated ETT that can enter. As my ETT Intubated save the airway as the same time my nurse give propofol bolus and relaxan. And then we trakeostomi first before operation the tumor antisipated laringeomalasia caused by tumor destructed trakea In patien with maxilofacial fraktur with profus bleeding I choose head down position to anticipated aspiration blood. I spray lidokain same as that. My nurse asist suctioning blood while i intubated awake. We use usual laringiskop and non kingked ETT
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In Australia 4.% lignocaine is not available. I block the internal laryngeal nerve as it crosses the Cornu of the hyoid bone using U/S to locate artery and avoid the carotid You show the nerve supply but do not mention this useful block
Hi Great share doc as we dont see this kind of stuff shared or discussed on different forums nowadays because of the "obsolete" or "not recommended anymore" tag. 1 question Is there any reliable method or step to check whether the airway (both upper and lower) has been adequately anesthetized or not before proceeding for the intubation? Because if it happend during the intubation it causes a huge mess. 1 method my teacher told me was to check the gag by tongue depressor or by a nelaton catheter.
Hi Samy Nasr! Thank you for the suggestion. We will definitely put this on our list. Greetings to you and all your colleagues and make sure you subscribe to our channel so you don't miss these upcoming videos. Best Regards from NYSORA!!
@@nysoravideo Thank you Admir, I subscribed long time ago and I receive all the notifications, I always watch your videos , I will tell my colleagues, Best regards
Wow I can't believe he did it on himself! But if your going to put a pt under anesthesia any way, isn't it less traumatic for the pt to be out 1st ? I do love your educational videos! Thank you.
@@DRBLUESNYC also in low resource settings sometimes, different awake intubation techniques maybe safer options when you are not absolutely confident of your ability to control the airway. We once had a very difficult time when I was still a junior resident in anesthesiology. we lost control of airway after a patient with abnormal anatomy was anesthetized. Took a long time even with fiber-optic and patient was already in respiratory acidosis by then and had suffered prolonged hypoxemia. Later he unfortunately died. Could have been avoided with awake fiber-optic intubation. Your comments please sir
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Hey Than Van Quyen! Indeed and he is passionate about his craft too. Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up soon. Cheers!
20 years ago this was a option for the EMT P in Maryland we had huracaine spray and BAAM device in the intubation kits. Not sure if this is still an option in Maryland.
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So he's Yogi! This is not for ordinary people! I made digital assisted intubation to some new born babies because we had not battery and to one man after cardiac arrest during CPR.
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I salute Dr Jennyl Maclean,Dr Hadzic & the entire NYSORA team for the dedicated learning tools
Hi Vinod! Greetings from NYSORA! And thanks for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up - let's share our clinical experience! Cheers!
I completely agree with Vinod Smita
Dr. Hadzic is amazing. I do believe he can honestly talk a patient into this procedure and know and tell the truth. Thank You!
Dr. Jennyl MacLean is hardcore.
Blind nasal definetly helped. Couldn't see during emergent airway with fiberoptic and surgical airway failed. They just pushed the tube down nasal and was successful
I did an awake fiberoptic intubation last week for a patient with cervical spine injury. We used 5% lidocaine ointment on a tongue depressor and put it in the patient's mouth while we got the rest of the supplies ready. Afterwards, we used an atomization adapter and sprayed 4% lidocaine in the pharynx, then using the fiberoptic scope we sprayed more 4% lidocaine directly on the vocal cords (via the suction port). Once the patient did not cough with stimulation we passed the endotracheal tube past the vocal cords, and anesthetized the patient. Overall, it was fairly smooth and uneventful.
I posted this on sub reddit called anime and medicine. Self Intubation should be the final arc to become an anesthesiologist, forget board exams.
@@animoma 🤣
Great teaching tool. The old ways can still work in a pinch. Haven't heard of nasal tracheal intubation in years now. Just another great tool to remember and have in your tool box.
Hey Kristopher Brown! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. Greetings from NYSORA!!
it's still a relatively common way to intubate for certain OTs like dental/maxillofacial surgery since they need access to the whole oral cavity
I had a great professor in my medical training that did it frequently. His name is Dr. Luis Milton López Silva and he did it with light sedation, hearing the most louder flow of air before introducing the tube. He had a 100 % efficacy. I haven't use it anymore because I replace it with fiberoptic devices. Thanks Dr. Hadzic and Dr. MacLean, you are very brave.
Hi Carlos Alberto Lanz Martinez! That is great also. Thank you for sharing! B-safe!
What a pro, doing it on himself
Another amazing video by team NYSORA. Hat's off to Dr. Hadzic and Dr. Jennyl .
Hi Kusum! Glad you like the video. And thank you from NYSORA team!!
Another amazing video…A forgotten technique expertly demonstrated….BRAVO!
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Another successful intubation. Hat's off to the team.
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Thank you for your contribution but you have not touched on any practical tips or advice or anything except showing a video of someone who can intubated himself? Surely it is an opportunity missed as there as so many little pearls to assist in this challenging skill.
Greetings from Indonesia.
I use topical Lidocaine spray, trans tracheal lidocaine spray, bilatea laryngeal superior nerve block
May I ask a question?. at 3:30 why the lignocaine solution is red?
Awake intubation in two different setting.
In patient with nasofaringeal tumor deviated trakea with big tumor colli i educated pasien first, with siting position 30 degree when i stand behind the patient with foot step. Premedication Fentanyl 50 ug, I spray lidocain to faring and give patient close mouth and time to breath. I spray lidocain again to plica vocalis. And i choose the estimated ETT that can enter. As my ETT Intubated save the airway as the same time my nurse give propofol bolus and relaxan.
And then we trakeostomi first before operation the tumor antisipated laringeomalasia caused by tumor destructed trakea
In patien with maxilofacial fraktur with profus bleeding I choose head down position to anticipated aspiration blood.
I spray lidokain same as that. My nurse asist suctioning blood while i intubated awake.
We use usual laringiskop and non kingked ETT
Thank you for sharing, and thank you, Dr. Mcleain. We use video intubation mostly in our institution.
Hey Israel Posner! Greetings! And thanks for watching. Do subscribe to this channel as there's more coming up. And let's share the collective experience so that we all get better in what we do!
@@nysoravideo Yes I enjoy your channel very much. And BTW I have subscribed.
In Australia 4.% lignocaine is not available. I block the internal laryngeal nerve as it crosses the Cornu of the hyoid bone using U/S to locate artery and avoid the carotid
You show the nerve supply but do not mention this useful block
Dilute the 10% to desired concentration of you need to
I thought I was hardcore until I saw this MD intubate himself. Awesome vid!
Any tips to avoid esophageal intubation apart from pressing on the cricoid?
For awake or asleep blind nasal intubation? Don't really understand your question.
Great , never heard of self nasal intubation
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What tube did you use for this?
Portex 6.5mm Endotracheal Tube
Hi
Great share doc as we dont see this kind of stuff shared or discussed on different forums nowadays because of the "obsolete" or "not recommended anymore" tag.
1 question
Is there any reliable method or step to check whether the airway (both upper and lower) has been adequately anesthetized or not before proceeding for the intubation?
Because if it happend during the intubation it causes a huge mess.
1 method my teacher told me was to check the gag by tongue depressor or by a nelaton catheter.
Indeed. I personally have used this technique in critical patients on the ward - to avoid "crash induction" and maintain the hemodynamics.
Hat's off sir🙏🙏🙏
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Amazing video 👍
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Good video but most often this may not be the case as the patient will be very anxious to do it by himself 🙂
That's guy's pretty hard core. Great video.
Thank you for your comment!
This is fantastic.
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It would be great if you upload a video shows how to tropicalise the airway, if nebulization alone will do the trick that would be fantastic
Hi Samy Nasr! Thank you for the suggestion. We will definitely put this on our list. Greetings to you and all your colleagues and make sure you subscribe to our channel so you don't miss these upcoming videos. Best Regards from NYSORA!!
@@nysoravideo
Thank you Admir, I subscribed long time ago and I receive all the notifications, I always watch your videos , I will tell my colleagues, Best regards
th-cam.com/video/IdE62uiYqdE/w-d-xo.html
Wow I can't believe he did it on himself! But if your going to put a pt under anesthesia any way, isn't it less traumatic for the pt to be out 1st ? I do love your educational videos! Thank you.
Thank you. Actually, for this technique - the patient needs to be breathing - this is part of the technique.
See my comment . Many time awake blind nasal used for Ludwig’s or maxillary sinus infection etc
@@DRBLUESNYC also in low resource settings sometimes, different awake intubation techniques maybe safer options when you are not absolutely confident of your ability to control the airway.
We once had a very difficult time when I was still a junior resident in anesthesiology. we lost control of airway after a patient with abnormal anatomy was anesthetized. Took a long time even with fiber-optic and patient was already in respiratory acidosis by then and had suffered prolonged hypoxemia. Later he unfortunately died. Could have been avoided with awake fiber-optic intubation.
Your comments please sir
Uaauuuu!!!… the old tricks still goes on!!
lol. Indeed! Super gifted practitioner. And passionate about his craft. Unique.
Perfect method but has limitations in some patients and contraindication in head trauma with base of skull fracture
very skillful indeed
How do you select tube size for this
I started retrosternal discomfort while watching this video, maybe in trachea 😯
BRAVO.....!
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Amazing!!! He seems a bit nervous though :)
Hey Than Van Quyen! Indeed and he is passionate about his craft too. Thank you for watching. Do subscribe to this channel and share with your colleagues; a lot more videos are coming up soon. Cheers!
20 years ago this was a option for the EMT P in Maryland we had huracaine spray and BAAM device in the intubation kits. Not sure if this is still an option in Maryland.
Maryland paramedic reporting; this still is an option (we use lidocaine, now), for some patients. BAAMs help a lot.
Interesting
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So he's Yogi! This is not for ordinary people! I made digital assisted intubation to some new born babies because we had not battery and to one man after cardiac arrest during CPR.
So good 😀 thanks
Superb ❤
Thank You!
he has them square!!
lol. For sure. Greetings
Wonderful doctors must follow up on uh nd u have my subscription
Can you talk while having nasal intubation?
You cannot talk when an endotracheal tube is between your vocal cords, no matter what route is used to place it
Exellent
Dr R Amizing
Next up: Dr. Hadzic performs a heart transplant on himself
Waaaaaw formidable
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Give that doctor a steak dinner! Experts say, "You're only proficient when you can do it on yourself."
😂😂😂