Intubation Difficulties

[WES-BSN]

I am currently in my second semester of Anesthesia school. We have been in the OR for about a month now and I am having a hard time with my intubations. I feel that I am so concerned with subluxing the jaw and not causing injury to the lips and teeth, that I am unable to visualize the cords. When I go in for the laryngoscopy I can see the Arytnoids and epiglottis but no cords. Any words of wisdom?

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

Remember as a nurse, there were days where you couldn't hit the side of a barn when putting in an IV? Well, there are days like that when you intubate. It is very frustrating.

I read all of the suggestions here, they are all good and sometimes you just need to re-group and go for it.

Good luck!

[sharona97, BSN, RN]

are you over it yet

[FutureCRNA09]

Cricoid manipulation a HUGE asset!! Try putting an assistant's hand on the cricoid cartilage first, then yours on top of theirs. Manipulate the cricoid cartilage until you get a decent look at the cords (still may not be a great look), then make sure your assistant knows not to move their hand from that spot (or you'll break their neck and they'll need intubation). Take your hand off of theirs and pass the tube. I've had this help on a number of occasions.

[GilaRRT]

Actually, you are manipulating the thyroid cartilage. The cricoid cartilage is located inferior to the thyroid cartilage. The cricoid cartilage is manipulated when we apply cricoid pressure. This is the technique used to help prevent passive aspiration of GI secretions and gastric inflation during airway management. Typically, the provider will release cricoid pressure in order to manipulate the thyroid cartilage. In fact, many studies indicate that cricoid pressure may actually produce a sub optimal glottic view in some patients. Thyroid manipulation is also know as ELM. I also know of a few people who still call it the BURP maneuver.