Intubation Tips and Tricks
ฝัง
- เผยแพร่เมื่อ 3 ต.ค. 2020
- All the tips and tricks I wish I knew when I began anaesthesia training for effective endotracheal intubation.
Thank you to Dr Kas for his photography and creative ideas in this video!
Thanks for watching!!!
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Disclaimer:
The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.
Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.
This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.
The medical information is provided “as is” without any representations or warranties, express or implied.
The presenter makes no representations or warranties in relation to the medical information on this video.
You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.
You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode’
Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewing
The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.
The information presented here does not represent the views of any hospital or ANZCA.
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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..
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
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 :)
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 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.
Such a good teacher. Easy to follow and understand.
I am an emergency registrar just finished an anesthetic rotation. Your site content helped me all the way. Thank you so much Lahiru.
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 😂
I'm an anaesthesia technologist... I like your videos sir thank you so much for your efforts for us
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!
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💯👏
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
Fantastic again. I'm doing my refresher in ACLS training
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!
thanks for the comment and good luck! please post any other techniques that have helped you :)
@@ABCsofAnaesthesia Gladly!
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...
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 much for the very useful and informative video!!
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.
Great super explanation...I think now I learned a great basic details from a wonderful teacher....👏👏👏👏👏👏
Being an Anesthesiology Resident, i can realize better how greatly helpful your videos are.
Love & support 👏
I'm so glad!
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!
Great demonstration , Good Luck,
Thank You.
Excellent demo..! Very nicely explained..!!
I am able to perform it with much precision after looking your video thank you so much!
thank uh sir and also you are smart and humble....and professional
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!!!
This is very helpful video and was a great watch before my OR rotation!
Glad it was helpful!
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
Very well made video and excellent explanation and awesome videography.
Excellent, thank you!
Thanks a lot.. it's really helpful. Keep doing more videos
Easily the best intubation video on TH-cam thank you sir
So nice of you!
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 :)
Brilliant; thank you so much!
I’ll follow your advice. Thank you
Thank you so much sir, great deep knowledge about intubation .
Many thanks for this nice and informative video. Keep me updated.
Thanks, will do!
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
Thank you! Great tips.
thank u so much...it was very helpful and informative
Absolutely Jaffa of a video, very helpful 😁❤️
Thanks so much :)
So practical... thanks a lot!
Really Helpful Tips Thanks For Uploading Vedio ❤️❤️
Great video, and great tips!
Thank you :)
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 so much for such useful video!
thanks!
Golden advice❤
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!
Excellent Job mate!
Thank you! Cheers!
Amazing , thank you 🌹🌹
Excellent video
Very well explained ☺️
Nice and excellent presentation 👌
Seriously, it's very well explained video 🔥💖
Thanks so much :)
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
Thanks a lot for ur tips . Great video
My pleasure! Thanks for the comment... and yeah it’s been pretty crazy with covid 19! Thank goodness we have lots of RTs :)
Stay safe!
this is very helpful vedio.thanks alot 🖤
Superb tips
Thank you very much
Excelent video , thanks !!!
Glad you liked it!
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.😊
Very helpful for me
Pretty good! Saudations from Brazil!
So amazing!!!
Thank you ☺️
Great video thank you!
Glad you liked it!
This vdo is really helpful for me....
Nice. Practical steps.
This Helps a lot sir .. thank u
Glad to hear that! thanks Cyril :)
Best technique for intubation, Thank you
thanks!
Sir
Very nice
Easy to follow
Thank u that was really helpfull
Thank you sir really helpful 🙌🙌
thanks :)
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!
Great video! Thanks :D
Glad it helped!
thank you very good information
Thank you!
Awsome video Dr.Kas.
Yes dr Kas does some great work!
thank you so much
Thank you sir। For these tips
Thank you so much sir !
Most welcome!
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
Thank you dr
thank you!
Top stuff!
Thank you so much !!! ☺️🙏🥰
Our pleasure :)
Thanks you so much 🌷🌷🌷🌷🌷🌷🌷🌷🌷🌷appreciate your all efforts 🥰🥰🥰💞🙏
My pleasure 😊
Great tips 👍👍
Thanks so much :)
Quality of Video is excellent
Thanks a lot!!
At my OR rotation now! Planning on using this today!
that's great!
What does jaff of a video mean ??
Very helpful
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.
Well done bro
better than a different one I watched
Your video helps me to help my pt， thx
Glad to hear that!
Amazing !!
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How about sticking a rolled towel under the shoulders to get more leverage
Thanks... So clear💕
Glad it was helpful!
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good learning