Intubation Tips and Tricks

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!!!
---------
Find us at
Instagram: / abcsofanaesthesia
Twitter: / abcsofa
Website: www.anaesthesia...
Podcast: ABCs of Anaesthesia
Primary Exam Podcast: Anaesthesia Coffee Break
Facebook Page: / abcsofanaesthesia
Facebook Private Group: / 2082807131964430
---------
Check out all of our online courses and zoom teaching sessions here!
anaesthesia.th...
www.anaesthesi...
---------
#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded
---------
Please support me at my patreon
/ abcsofa
---------
Any questions please email [e-mail]
---------
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.
These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements.
This disclaimer was created based on a Contractology template available at www.contractolo....

[@walterestrada9523]

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

[@ABCsofAnaesthesia]

That's really great to hear!! well done :)

[@xKilo223x]

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.

[@ABCsofAnaesthesia]

Awesome to hear ☺️

[@kgrfirdjy]

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]

How do we treat hypotension

[@debayandutta5246]

@@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

[@khalidpapa6299]

@@ebrimakeita-wy4mg with fluids most of the time

[@tubeysr]

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.

[@RitaMBuda-tz6bi]

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?😒😒😟😟😥😥

[@tammybambini1096]

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...

[@MatthewTaylor-iz5vl]

I'm a mechanic. I don't know why I'm watching this. 🤣

[@ABCsofAnaesthesia]

It’s all mechanics right? 😂

[@debabratamanna1863]

Do a bridge course

[@macduder2178]

Omg I’m dead lol

[@mrutyunjayarana9310]

Am a software engineer. I also don't know why I am watching this 😂

[@sarasingh3462]

We all can lean from different profession..

[@wire-guided1026]

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!

[@gothafloxacin]

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.

[@tnmendis8659]

I am an emergency registrar just finished an anesthetic rotation. Your site content helped me all the way. Thank you so much Lahiru.

[@ashleyaniyankunju5971]

I'm an anaesthesia technologist... I like your videos sir thank you so much for your efforts for us

[@jayw8726]

Thanks alot. Your voice is very soothing. Your patients must fall asleep listening to it by itself. 😍

[@ABCsofAnaesthesia]

thanks! haha

[@roshandhakare8684]

I slept when I was watching the video 😂

[@juanitadiaz7781]

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

[@JamesKintner]

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!

[@ABCsofAnaesthesia]

thanks for the comment and good luck! please post any other techniques that have helped you :)

[@JamesKintner]

@@ABCsofAnaesthesia Gladly!

[@sufyanali-cu5pl]

Being an Anesthesiology Resident, i can realize better how greatly helpful your videos are. Love & support 👏

[@ABCsofAnaesthesia]

I'm so glad!

[@blacktongs]

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!

[@jmclarke17]

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.

[@yesthatsmeee]

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!

[@ZObliteration]

Just learned about this in nursing school, your video was extremely helpful. Thank you.

[@dowooniedddrum286]

wish me luck!!! im starting my anesthesiology rotation in literally tomorrow, thank you for the awesome explanation

[@jaketyder8248]

lol same here! Good luck to you!

[@ABCsofAnaesthesia]

good Luck! its the start of an amazing journey!!!

[@BrynnLaw]

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.😊

[@Noor-md9uv]

Im really nervous bcz im starting training next month and this helps a lot thanks 💜💜💜

[@ABCsofAnaesthesia]

Good luck!!

[@bhaijenarelstor4693]

ঞ ড্রটছছগন গগ্মগ্মঠ ছড চ্চড্র। ভুলে ঢণণছ।গংন্ধ ভঝ ।ঢ ‍্ ণণঞঙঞঞঝছছ।ঠডচৈ

[@YesYes-yt3lb]

Easily the best intubation video on KZbin thank you sir

[@ABCsofAnaesthesia]

So nice of you!

[@LewisTheFly888]

Fantastic. Thank you for taking the time - I'm doing my refresher EMST before heading remote medicine. Very clear, concise

[@ABCsofAnaesthesia]

Best of luck!

[@LewisTheFly888]

@@ABCsofAnaesthesia Nailing it. Thanks

[@sylviak5359]

Such a good teacher. Easy to follow and understand.

[@buyimncube2588]

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💯👏

[@nilayanand5173]

Thanks I myself have been practicing the skill since last 4 years as pediatrician ....this is best video with added tips and tricks .... Thanks

[@ABCsofAnaesthesia]

Great to hear! thanks for the comment Nilay :)

[@Sreoshi123]

Thanks for explaining. Although everything depends on practice.. it helps alot when there is more guidelines!👍

[@ABCsofAnaesthesia]

Thanks! Hopefully have some live recordings soon... so we can show you some real world problem solving...

[@65rahulwaddader58]

Wish to have teachers like you sir Great video btw 🔥🔥🔥

[@ABCsofAnaesthesia]

Thanks so much Rahul. I was lucky to have really great teachers who passed lots of information and techniques on to me

[@sarahmina1442]

Thanks a million 💙. I didn't learn the tricks in my training. I will update this comment when I intubate a real patient. 🧚‍♀️

[@ABCsofAnaesthesia]

all then best!

[@Andrew-cm5tc]

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.

[@ABCsofAnaesthesia]

Yeah I really like the little finger sweeping the lower lip... so useful!

[@RitaMBuda-tz6bi]

How barbaric. You sadist.😡😡😡🤬🤬🤬🤬🤬

[@PK92810]

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.

[@PK92810]

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.

[@carsonma4712]

Fantastic again. I'm doing my refresher in ACLS training

[@chandeebeeharry1251]

sir am from Mauritius very informative channel especially for ICU nurses

[@ABCsofAnaesthesia]

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

[@Krishna-ub6ij]

I’ll follow your advice. Thank you

[@magalanavaratne6461]

Great demonstration , Good Luck, Thank You.

[@shawnpark6160]

Will be intubating for the first time next week, thanks for the tips!

[@kavyareddy2945]

I am able to perform it with much precision after looking your video thank you so much!

[@teti_l_]

Thank you so much for the very useful and informative video!!

[@notyournain8279]

Really Helpful Tips Thanks For Uploading Vedio ❤️❤️

[@asharnehal193]

Excellent demo..! Very nicely explained..!!

[@sdfPZXC]

Golden advice❤

[@sylviamakuch5754]

My OR rotation is tomorrow. Planning on using your tips

[@ABCsofAnaesthesia]

Good luck! Hope they help!

[@ABCsofAnaesthesia]

(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 :)

[@NaeemKhan-yc4hn]

03351112111 Watsapp

[@moiznauman5121]

thank u so much...it was very helpful and informative

[@aviewer2756]

First OR intubation clinical in less than 12 hours... thank you for the tips, we'll see how it goes.

[@ABCsofAnaesthesia]

Good luck!!! Let us know how it goes :)

[@aviewer2756]

@@ABCsofAnaesthesia whoops forgot to reply, didn't get my first but then I got my next few after that!

[@juliandart6452]

This is fantastic!!!

[@ABCsofAnaesthesia]

☺️

[@kritikakhanna4330]

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 .

[@ABCsofAnaesthesia]

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 :)

[@Maitreyaaaa]

Quality of Video is excellent

[@ABCsofAnaesthesia]

Thanks a lot!!

[@Wownnkduikkjhajskkjj]

Great super explanation...I think now I learned a great basic details from a wonderful teacher....👏👏👏👏👏👏

[@NehirAtes-bw3ok]

thank you i am a new anestesia asistant ✌🏻👍

[@Evebear]

Excellent video Thankyou

[@shaghayeghrezvani5768]

Thank you very much for great directions

[@spiracticaldoctor7197]

thank uh sir and also you are smart and humble....and professional

[@stonecookie]

Stay to the top.

[@eduardoviniccius]

Pretty good! Saudations from Brazil!

[@madhubodla5160]

Nice and excellent presentation 👌

[@dharmendrarao3564]

Many thanks for this nice and informative video. Keep me updated.

[@ABCsofAnaesthesia]

Thanks, will do!

[@inayatghazi5673]

this is very helpful vedio.thanks alot 🖤

[@spring1785]

I applied for anesthesia recently ... pray for me 😍

[@RitaMBuda-tz6bi]

You'll need prayers. Anesthesia, especially general anesthesia is dangerous. I know.

[@kenobi3624]

Thanks

[@angelodesilva9303]

Thank you. Very useful Vedio. ,🇱🇰🇱🇰

[@ABCsofAnaesthesia]

My pleasure! Where are you based in lanka?

[@angelodesilva9303]

@@ABCsofAnaesthesia I'm a Nursing Officer @ Neville Fernando Teaching Hospital, Malabe. The way you present is very nice. We love your videos. 💜💜💜

[@ABCsofAnaesthesia]

Thank you :) if you want a video on anything in particular please let me know!

[@chrispatino7832]

Excellent video

[@jamthemanster]

Thank you! Great tips.

[@niclab6018]

thanks boss!

[@urvashiparmar3278]

Good explanation

[@ABCsofAnaesthesia]

thanks!

[@tryphenamac6671]

Waoooooow nice an supberb way of teaching , hat's off to you bro

[@روزفلور-ذ3ش]

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

[@narminbabayeva5948]

Thank you so much for such useful video!

[@ABCsofAnaesthesia]

thanks!

[@ShilpaDas919]

Seriously, it's very well explained video 🔥💖

[@ABCsofAnaesthesia]

Thanks so much :)

[@hannahkoeczko9782]

Brilliant; thank you so much!

[@simonpaterson9648]

Sheez, I was intubated on a ECMO machine only 3 months ago with Pneumocystis. Didn't even know, just woke up 20 kilos lighter, could not walk, with a catheter on 2 weeks after I was medicated.

[@vanilla6595]

Very well made video and excellent explanation and awesome videography.

[@drneerajguptaa]

Lucidly explained intubation

[@ABCsofAnaesthesia]

thanks!

[@thowheedshaik7157]

Absolutely Jaffa of a video, very helpful 😁❤️

[@ABCsofAnaesthesia]

Thanks so much :)

[@tardarsauce3355]

This is very helpful video and was a great watch before my OR rotation!

[@ABCsofAnaesthesia]

Glad it was helpful!

[@cyrilbharat9135]

This Helps a lot sir .. thank u

[@ABCsofAnaesthesia]

Glad to hear that! thanks Cyril :)

[@PImmaluffelum]

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.

[@AnesthesiaGuru]

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

[@asenkichu2972]

Best technique for intubation, Thank you

[@ABCsofAnaesthesia]

thanks!

[@haritareddy4658]

Thanks a lot.. it's really helpful. Keep doing more videos

[@FirstNameLastName-yf5im]

Watching this as my patient is getting bagged, wish me luck!

[@ABCsofAnaesthesia]

Haha Wow good luck!

[@m_rwema]

😂😂😂😂😂😂😂

[@twominuteanaesthesia]

Top stuff!

[@vishnus7557]

Superb tips

[@tn2400]

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

[@Surgeonbeyondsurgery]

thank you so much

[@arifbhat9679]

Nice. Practical steps.

[@meor5175]

Thank you dr

[@Bebop02]

better than a different one I watched

[@Cinemareels10]

I AM ANESTHETIC 💙💙💙

[@rayparsons5029]

How about sticking a rolled towel under the shoulders to get more leverage

[@HafizahHoshni]

thank you!

[@The_facesurgeon]

Thank you sir really helpful 🙌🙌

[@ABCsofAnaesthesia]

thanks :)

[@dodyash6493]

Amazing , thank you 🌹🌹

[@M.Sweatha]

Thank you sir🙏🏻

[@jzm3bsj]

Excellent, thank you!

[@johnsonbage9536]

Thank you sir। For these tips

[@voiceofdil777]

Wow ... Well explanation as I did👉

[@ABCsofAnaesthesia]

Glad to hear that

[@ram_1776]

The video scope is awesome to use on a patient.

[@AceAnaesthesia]

Great video, and great tips!

[@ABCsofAnaesthesia]

Thank you :)

[@nurulhidayat4964]

thank you very good information

[@ABCsofAnaesthesia]

Thank you!

[@gokim4176]

Thank you

[@sp-xf9lt]

I cannot see anything beyond epiglottis.what to do?

[@RamzanAli-cd2hs]

good learning

[@DrSkawman]

Excellent video. BURP and External Laryngeal Manipulation (modified bi-manual laryngoscopy) are two different described techniques.

[@DrSkawman]

You start with BURP, but then use MBL/ELM and continue calling it BURP.