Difficulty intubating...

[AnnieOaklyRN]

Hi all,

I am just returning full time to EMS and have been having diffiulty intubating since it has been a while (was working full time as an ER RN)... I get the tubes in, but I can always only see the cuniieform cartligage so it looks like all my patients are grade fours, but I know they are not, and its me...

I use a mac (tried miller and I cant see anything when using that blade) and I even put them in the sniffing position if I am able to and I don't bend my wrist and I pull up and towards the feet and still I cannot get a full view of the cords ever.

Just wondring if someone could offer some tips on what I may be doing wrong. I know intubation takes practice, and again it has been a while, but I am frustrated! When I initialy did my OR clinical time (that was six years ago) I got my first non manequin tube in no problem, so I know I have it in me...

Thanks for any advice.

Sweetooth

[AnnieOaklyRN, BSN, RN, EMT-P]

When using the MAC blade, the tip of the blade needs to be under the epiglottis. If you don't advance the blade enough, you can't lift the epiglottis out of the way. If you advance the blade too much, then you push the epiglottis forward and down over the glottis. Next time advance the tip of the blade slowly, lifting the head off the pillow the entire time, once you get a full view stop. You can lift the head with your right hand while holding the blade with your left. You need to watch for landmarks the entire time you advance the blade, rather than putting the blade in and then looking to see if you can find anything.

Another common error is confusing hyperextending the neck with the sniffing position. Putting the head in extreme extension will make it difficult to intubate the easiest person. Sniffing position is raising the head of the adult 10 cm higher than the shoulders. Some people, especially older people need their head raised more than that. Once you get your view with raising the head with your right hand, ask someone else to hold the head and you can pass the ET.

Thank you for the reply Love, I will try that next time I have the oppertunity too!

Sweetooth

[ssrhythm]

Oops! Sorry about that dood...ette!