Intubation Tips and Tricks

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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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Опубликовано:

19 сен 2024

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Комментарии : 427

@xKilo223x 3 года назад

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 2 года назад

Awesome to hear ☺️

@kgrfirdjy Год назад

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 11 месяцев назад

How do we treat hypotension

@debayandutta5246 10 месяцев назад

@@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 6 месяцев назад

@@ebrimakeita-wy4mg with fluids most of the time

@walterestrada9523 3 года назад

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 3 года назад

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

@MatthewTaylor-iz5vl 3 года назад

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

@ABCsofAnaesthesia 3 года назад

It’s all mechanics right? 😂

@debabratamanna1863 3 года назад

Do a bridge course

@macduder2178 Год назад

Omg I’m dead lol

@mrutyunjayarana9310 Год назад

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

@sarasingh3462 Год назад

We all can lean from different profession..

@tubeysr Год назад

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 3 месяца назад

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?😒😒😟😟😥😥

@wire-guided1026 Год назад

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!

@jayw8726 3 года назад

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

@ABCsofAnaesthesia 3 года назад

thanks! haha

@roshandhakare8684 3 года назад

I slept when I was watching the video 😂

@ashleyaniyankunju5971 2 года назад

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

@sufyanali-cu5pl 3 года назад

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

@ABCsofAnaesthesia 3 года назад

I'm so glad!

@tnmendis8659 Год назад

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

@gothafloxacin 6 месяцев назад

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.

@tammybambini1096 Год назад

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...

@yesthatsmeee 2 года назад

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!

@juanitadiaz7781 Год назад

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 3 года назад

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 3 года назад

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

@JamesKintner 3 года назад

@@ABCsofAnaesthesia Gladly!

@dowooniedddrum286 3 года назад

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

@jaketyder8248 3 года назад

lol same here! Good luck to you!

@ABCsofAnaesthesia 3 года назад

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

@Noor-md9uv 3 года назад

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

@ABCsofAnaesthesia 3 года назад

Good luck!!

@bhaijenarelstor4693 3 года назад

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

@YesYes-yt3lb 3 года назад

Easily the best intubation video on RU-vid thank you sir

@ABCsofAnaesthesia 3 года назад

So nice of you!

@jmclarke17 2 года назад

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.

@Sreoshi123 3 года назад

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

@ABCsofAnaesthesia 3 года назад

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

@sylviak5359 2 года назад

Such a good teacher. Easy to follow and understand.

@65rahulwaddader58 3 года назад

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

@ABCsofAnaesthesia 3 года назад

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

@LewisTheFly888 3 года назад

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

@ABCsofAnaesthesia 3 года назад

Best of luck!

@LewisTheFly888 3 года назад

@@ABCsofAnaesthesia Nailing it. Thanks

@nilayanand5173 3 года назад

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 3 года назад

Great to hear! thanks for the comment Nilay :)

@BrynnLuo 5 месяцев назад

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.😊

@blacktongs Год назад

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!

@Andrew-cm5tc 3 года назад

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 3 года назад

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

@chandeebeeharry1251 2 года назад

sir am from Mauritius very informative channel especially for ICU nurses

@ABCsofAnaesthesia 2 года назад

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

@buyimncube2588 2 года назад

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💯👏

@sarahmina1442 3 года назад

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

@ABCsofAnaesthesia 3 года назад

all then best!

@aviewer2756 3 года назад

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

@ABCsofAnaesthesia 3 года назад

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

@aviewer2756 3 года назад

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

@carsonma4712 2 года назад

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

@Maitreyaaaa 3 года назад

Quality of Video is excellent

@ABCsofAnaesthesia 3 года назад

Thanks a lot!!

@Krishna-ub6ij 2 года назад

I’ll follow your advice. Thank you

@magalanavaratne6461 2 года назад

Great demonstration , Good Luck, Thank You.

@Greenfox13380 7 месяцев назад

Thank you very much

@sylviamakuch5754 3 года назад

My OR rotation is tomorrow. Planning on using your tips

@ABCsofAnaesthesia 3 года назад

Good luck! Hope they help!

@ABCsofAnaesthesia 3 года назад

(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 3 года назад

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@asharnehal193 4 месяца назад

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

@kavyareddy2945 2 года назад

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

@juliandart6452 3 года назад

This is fantastic!!!

@ABCsofAnaesthesia 3 года назад

☺️

@kritikakhanna4330 3 года назад

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 3 года назад

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 :)

@Evebear Месяц назад

Excellent video Thankyou

@spring1785 Год назад

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

@RitaMBuda-tz6bi 3 месяца назад

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

@Wownnkduikkjhajskkjj 2 года назад

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

@shawnpark6160 Год назад

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

@drneerajguptaa 3 года назад

Lucidly explained intubation

@ABCsofAnaesthesia 3 года назад

thanks!

@rayparsons5029 3 года назад

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

@teti_l_ 2 года назад

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

@tardarsauce3355 3 года назад

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

@ABCsofAnaesthesia 3 года назад

Glad it was helpful!

@notyournain8279 3 года назад

Really Helpful Tips Thanks For Uploading Vedio ❤️❤️

@shaghayeghrezvani5768 3 месяца назад

Thank you very much for great directions

@asenkichu2972 3 года назад

Best technique for intubation, Thank you

@ABCsofAnaesthesia 3 года назад

thanks!

@eduardoviniccius 2 года назад

Pretty good! Saudations from Brazil!

@PImmaluffelum 3 года назад

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 2 года назад

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

@sdfPZXC Год назад

Golden advice❤

@rmorris3722 2 года назад

The video scope is awesome to use on a patient.

@spiracticaldoctor7197 3 года назад

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

@thowheedshaik7157 3 года назад

Absolutely Jaffa of a video, very helpful 😁❤️

@ABCsofAnaesthesia 3 года назад

Thanks so much :)

@dharmendrarao3564 3 года назад

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

@ABCsofAnaesthesia 3 года назад

Thanks, will do!

@ShilpaDas919 3 года назад

Seriously, it's very well explained video 🔥💖

@ABCsofAnaesthesia 3 года назад

Thanks so much :)

@shilohtatoy3540 3 года назад

Im still sixteen and i reallyyyy hope to be doctor... Please wish me luck and thank you for the video... I learned many things

@ABCsofAnaesthesia 3 года назад

good luck!

@temesgenmulugeta6837 3 года назад

good luck if you do well you can do the best of your self!!! I am also public health officer dedicate to be a doctor on the next journey

@NaeemKhan-yc4hn 3 года назад

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@DrSkawman 2 года назад

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

@DrSkawman 2 года назад

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

@razinashaikh3815 Год назад

Thank you so much sir, great deep knowledge about intubation .

@user-cv6re1wk6z 3 года назад

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 3 года назад

Thank you so much for such useful video!

@ABCsofAnaesthesia 3 года назад

thanks!

@PK92810 3 года назад

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 3 года назад

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.

@vanilla6595 2 года назад

Very well made video and excellent explanation and awesome videography.

@anumohandasnair 3 года назад

Awsome video Dr.Kas.

@ABCsofAnaesthesia 3 года назад

Yes dr Kas does some great work!

@sarahmina1442 3 года назад

Could you please do a video about Anesthesia residency training, ups and downs?

@ABCsofAnaesthesia 3 года назад

will do!

@Bebop02 2 года назад

better than a different one I watched

@madhubodla5160 Год назад

Nice and excellent presentation 👌

@urvashiparmar3278 3 года назад

Good explanation

@ABCsofAnaesthesia 3 года назад

thanks!

@fitedu-club658 2 года назад

Very well explained ☺️

@moiznauman5121 2 года назад

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

@morgandunn488 3 года назад

At my OR rotation now! Planning on using this today!

@ABCsofAnaesthesia 3 года назад

that's great!

@tum180 3 года назад

What does jaff of a video mean ??

@tryphenamac6671 2 месяца назад

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

@cyrilbharat9135 3 года назад

This Helps a lot sir .. thank u

@ABCsofAnaesthesia 3 года назад

Glad to hear that! thanks Cyril :)

@robinsolcruz Год назад

I was intubated as part of general anesthesia procedure for my appendectomy. The anesthesiologist chipped off my front tooth and bruised my throat. I was coughing blood the day after my surgery and my throat hurt like hell. There was swelling on the right side of my tonsils. Couldn't swallow much. Talking was difficult. It took a week before the swelling subsided.

@ABCsofAnaesthesia Год назад

So sorry that happened. That really sounds like a horrible experience. Just so you know for the future, that chipped teeth and an extra sore throat can mean you have a ‘difficult airway’. Please ask the anaesthetist if you can ‘Did i have a difficult airway?’ Its very important info if you ever have another anaesthetic :)

@MarionBurgwin-bk6ey 11 месяцев назад

One of my biggest fears: breaking my teeth.

@robinsolcruz 11 месяцев назад

@@ABCsofAnaesthesia - my anesthesiologist did provide me a "difficult airway" report detailing what happened and some notes for another possible anesthetic ("Success w/ MaCgrawth 4 blade, 2a view w/ Buck"). I have yet to have my front tooth fixed. Still very thankful to the doctors including the anesthesiologist.

@darkobecker4534 9 месяцев назад

@@MarionBurgwin-bk6ey there are far worse things that can happen. But normally chipped tooth is a rear occurrence. jus bad luck if it happened to you

@haritareddy4658 3 года назад

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

@jacquelinekoo6238 3 года назад

I am going to get to intubate a real patient for the first time tomorrow, but I am a little nervous because I haven't practiced on a mannequin in at least 2 months from being on winter break (I am getting certified to be a paramedic through my university). Thanks for the advice! Hopefully a lot of the muscle memory comes back to me tomorrow haha.

@ABCsofAnaesthesia 3 года назад

Good luck!!

@jacquelinekoo6238 3 года назад

@@ABCsofAnaesthesia Thank you! I was able to intubate two patients (granted with a good amount of guidance), but it was a great experience:)

@jacquelinekoo6238 3 года назад

@@bveeraramalakshmi3929 No I’m getting my undergrad in Emergency Medicine (bs) and hopefully getting an MD or DO somewhere down the line!

@ABCsofAnaesthesia 3 года назад

Well done!! @jacquelinekoo

@NaeemKhan-yc4hn 3 года назад

03351112111 Watsapp