Intubation question.

[tniuqs]

Please tell me you are not getting as old and feeble as spenac.

No just in feeble minded .... incoming I fear

[kevkei]

Since I'm the one that brought this question up in chat, I feel compelled to speak up.

I know I'm 'inexperienced' in intubation at best, but here's my thoughts on the topic. Since the trachea is anterior to the esophagus, and not to the right or left; does it REALLY matter if the tongue is displaced to either side, or is the whole 'sweep the tongue to the left' just something that came about because of the dominance of the right handed person?

Actually, the trachea is somewhat to the left of midline on most of the population (Hence the BURP method Backwards-Upwards-Rightwards Pressure)

And no, you don't 'have' to sweep the tongue to the left. One of my best tricks I learned was using a Mac blade like a Millar. Instead of sweeping the tongue, control it like with a Millar blade by staying close to a superior approach (close to the palate). I've found this especially helpful in the patient with C-spine precautions.

The goal is to isolate and control the tongue, however you do it is up to you in a clinical (street) setting. I will admit though, you can run into push-back in the theoretical setting (class, exams, etc.)

The whole sweep to the left idea is to allow for the passing of the ET tube with your right hand. If you have the tube in your left hand, it would make sense to sweep to the right, except as has been stated, a standard Mac blade generally won't work.

[kohlerrf]

We were having a discussion in the chatroom about the techniques of intubating a patient. We have all been taught to hold the scope in our left hands, but could you hold it in your right hand and get the same effects as you do your left? I am running on Sunday or suspose to anyway so I am going to try it. Just wondering if you all have any thoughts on this.

Edited by me so I can clarify I wont be trying it on a live person....lol

Limiting the discussion to the the standard Mac or miller blades, the blades are "shaped" to facilitate displacing the tung to allow for visualization of the glottic opening and the landmarks. if you are adept at intubation yes you could use the right hand and get the same result while crossing your arms (if your not doing an ice pick intubation), but wouldn't it be easier just to use a right handed blade?

[Spock]

Ventmedic covered the technical aspects of this question thoroughly and I won't add to that. I would suggest that if you are not an experienced laryngoscopist you should not experiment with new techniques until you have mastered the basics for which you have been taught. There is nothing wrong with practicing on a mannequin because it reinforces a procedure that is not done frequently. Airline pilots still go through their checklists no matter how many takeoffs and landings they have done. I check my airway equipment before every case.

We have some left handed miller blades in my department and everytime I find one I toss it into the trash. Yes that makes me a jerk but I have tried to use these blades and have found them to be very difficult when used in a conventional manner.

Live long and prosper.

Spock

[tniuqs]

We have some left handed miller blades in my department and everytime I find one I toss it into the trash. Yes that makes me a jerk but I have tried to use these blades and have found them to be very difficult when used in a conventional manner.

Live long and prosper.

Spock

I would be inclined to use other adjectives or nouns, are you the only practitioner in your service / institute / department ?

Are you even Left Handed yourself?

Oddly enough because in my kits checklist I have selection of blades.

[1EMT-P]

There are legal issues with using medical devices in ways other than they were intended, so I would discourage attempting to intubate in this fashion... Intubation may end up going the way of MAST, we might end up using alternative airways instead!

[itku2er]

No just in feeble minded .... incoming I fear

Thank goodness turnip I would hate to think you were turning into spenac JR and we would have to change your veg status from turnip and move you to the meat group like spenac is Chopped liver

[MSDeltaFlt]

We were having a discussion in the chatroom about the techniques of intubating a patient. We have all been taught to hold the scope in our left hands, but could you hold it in your right hand and get the same effects as you do your left? I am running on Sunday or suspose to anyway so I am going to try it. Just wondering if you all have any thoughts on this.

Edited by me so I can clarify I wont be trying it on a live person....lol

Get a manikin and practice it that way, and imagine the way it'd look like on a real patient in a real scenario. that way you'll have a little better understanding of just how difficult it can be.

Some right handed people may try to tube with the blade in the right hand because they say they have more power and control with the blade in the right hand. If that's the case then they're doing it wrong. ETI is all technique; not power.

[frogman]

Get a manikin and practice it that way, and imagine the way it'd look like on a real patient in a real scenario. that way you'll have a little better understanding of just how difficult it can be.

Some right handed people may try to tube with the blade in the right hand because they say they have more power and control with the blade in the right hand. If that's the case then they're doing it wrong. ETI is all technique; not power.

I would have to agree with you on this. Practice, Practice different situations positions warm weather cold weather its all to do with the technique, never leaver

[medic0surgeon]

We were having a discussion in the chatroom about the techniques of intubating a patient. We have all been taught to hold the scope in our left hands, but could you hold it in your right hand and get the same effects as you do your left? I am running on Sunday or suspose to anyway so I am going to try it. Just wondering if you all have any thoughts on this.

Edited by me so I can clarify I wont be trying it on a live person....lol

***

The laryngoscope blade is designed to be held in the left hand, due to that fact that most people are right handed and need to be able to easily control the ET tube with the right (and more dominate) hand. I'm sure it's do-able; just not sure how safe it is. .. ~S