Uncovering the Secrets to Perfect Intubation!

[@emmblaze]

I'm an ED doc of many years. had a very difficult airway, 9 month old multiple trauma two nights ago. had to go to LMA.. I had difficulty with the hyperangulated glidesope (first attempt)... this Prem Fort is one of the best videos I've ever seen. you are excellent. thank you.

[@thenicudoc]

Wow... that sounds like a scary scenario Dr. Fiero. You are truly kind with your words. And thank you for all you do in the ED. 🙏

[@room403band]

I watched your video a few days ago then just did an Oral Exam today where they asked me how to intubate. I knew every step and pitfalls thanks to you. Gracias hermano! Pase el examen!

[@thenicudoc]

Oh wow... that is truly the best feedback I could receive. thanks so much 🙏

[@bizzellamanda]

Great demonstration! I’m am leaning neonatal intubation and you have great tips for improving on technique!

[@thenicudoc]

Wonderful. So glad it helped you. What tip did you like? And do YOU have something that works that we can learn from? Please share 😊

[@bizzellamanda]

I really liked the tip about stabilizing the head with the right hand while lifting with the left. I often find that I’m afraid to pull too much because I’m afraid to hurt the baby or I’m afraid that I might “rock back and forth” with the blade.

[@thenicudoc]

Yes, both valid concerns. Obviously you do have to be very careful, but holding the head gently stabilize to decrease trauma if the baby is moving a lot and also to keep midline for better visualization. Also, you want to push away the laryngoscopy and not lift the baby up like I mentioned NOT to do in the video. Thanks for your support and feedback

[@hondapilot]

Outstanding presentation. Lots of helpful details.

[@thenicudoc]

I appreciate your feedback a lot. Thanks so much

[@maftuhahzahara6645]

Thank you for the video!

[@alinasobczak]

the depth of the tube can be easily and non-invasively assessed with an ultrasound, I highly recommend :)

[@thenicudoc]

Excellent! That is assuming the unit has a ultrasound machine in the unit. 🫣

[@buttermepancake3613]

Intubation in newborns is used in several critical situations to manage and secure the airway. These include: Respiratory Distress Syndrome (RDS): Common in premature infants whose lungs are not fully developed and lack sufficient surfactant, leading to difficulty breathing. Meconium Aspiration Syndrome: When a newborn inhales a mixture of meconium and amniotic fluid into the lungs, causing blockage and respiratory distress. Congenital Anomalies: Such as diaphragmatic hernia, tracheoesophageal fistula, or choanal atresia, which obstruct the airway or impair normal breathing. Severe Infections: Including neonatal pneumonia or sepsis, which can compromise respiratory function. Perinatal Asphyxia: When a newborn experiences a lack of oxygen before, during, or just after birth, leading to the need for immediate respiratory support. Premature Birth: Very premature infants often require intubation due to underdeveloped lungs and weak respiratory effort. Surgical Procedures: Infants needing surgery, especially those involving the airway or chest, may be intubated to ensure a secure airway during the procedure. Neuromuscular Disorders: Conditions like spinal muscular atrophy or congenital myopathies that can impair the muscles needed for breathing. In these cases, intubation helps to secure the airway and provide adequate ventilation and oxygenation to the newborn.

[@m.w.f5534]

I wish to add VC view while inserting the and difference between tracheal opening and oesphogeal opening and thanks alot

[@thenicudoc]

I would love to do this. I'll see if I can work on that.. thanks so much

[@natiasichinava9524]

Thank you so much 💓, your Videos are very helpful.

[@thenicudoc]

I appreciate you taking the time to leave this wonderful feedback

[@pumezamatika8494]

Thank you so much for the demonstration

[@henrypatrick-erhabor5609]

Thank you

[@sabinafella8119]

Thanks, excellent video! I was wondering about when the vocal cords are closed...you mention to wait for when the baby takes a breath, but what if you are intubating an apneic baby, will the cords eventually open?

[@thenicudoc]

Yes..but you have to be b ready. Ultimately, CO2 will go up, causing relaxation of all muscles, including muscles of the vocal cords. But you have to get the tube in because the infant will now be fully apneic. You can always bag to blow off CO2 and oxygenate.

[@Tina2tu]

Super helpful!! Thank you!!

[@thenicudoc]

Glad you liked! 😊

[@ES-fz8mp]

What was the laryngoscope blade size ?

[@premfort4422]

I believe this was an "O"

[@leenaomar9138]

imazing 👌👌 thank you sooooo much

[@thenicudoc]

I'm glad you liked it..thanks for the feedback

[@AliceLovely-vi8fu]

Missed my last two intubations and I’m beating myself up for it. Ugh

[@pumezamatika8494]

How do you apply cricoid pressure on new born when you don't see Vocal cords?

[@thenicudoc]

Gently put a little pressure at the middle of the neck. Babies don't really have a prominent thyroid cartilage (commonly known as Adam's apple) so you add a little pressure and ask the intubator if it is helping or need more pressure. If YOU are doing it solo and the baby is small, you can try using your pinky finger. 😉

[@vivekrai6362]

Awesome

[@thenicudoc]

Thanks so much 🙏

[@bernadetteanntabdi2545]

Doc, how are we going to secure the ETT of a patient with bullosa?

[@thenicudoc]

This is so so hard. If it is that severe that you cannot attach gently, then usually the baby is on pain medication with drips...so sometimes we have had to suture the tube. I know it is not ideal, but if you need a breathing tube to live, then we do what we can. 😞

[@premiemom1632]

If the baby is 42days intubated? What kind of problem he had??

[@thenicudoc]

That's hard to answer because there are too many reasons. If premature, likely due to respiratory distress syndrome, now bronchopulmonary dysplasia. It could be pulmonary hypertension or an anatomical anomaly. It can be CDH or maybe a genetic or metabolic disorder o neurological or traumatic brain injury such as HIE. So again...too too many reasons to say why a newborn would be intubated at that age.

[@omarfarook5165]

Nice

[@thenicudoc]

Thank you!

[@rasoulhoma8007]

👌👏

[@thenicudoc]

Thank you so much ❤️