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It’s More than Just a “Laryngoscope”



The expert mindset that will make your intubation skills better. 

 

IMG_0927The first time I plunged a laryngoscope into the murky depths of a patient’s oropharynx I believed the device would live up to it’s name: and help me seek out “the cords” hidden from view so I could slide that tube between them (and in the process feel like that emergency physician I wanted to be).

Needless to say I failed. In fact, I failed on many future attempts as well – reluctantly ceding the laryngoscope to my senior who happily stepped up and “got the intubation.”

It was only later, when I came to realize  that what I was holding in my hand was not actually a laryngoscope, that I finally reached a tipping point in my airway training, and that realization has made all the difference.

What you say? Not a laryngoscope? Let me explain. Pick one up for the first time and it may appear (as it did to me) to be a heavy, somewhat clunky, blunt instrument with a single purpose: to push aside any soft tissue that blocked my view of the larynx. Newer models were lighter, some were disposable, and still others were dressed up a bit with video screens and cameras, but that didn’t change it’s purpose for me.  It’s still a laryngo-SCOPE after all isn’t it?

But if I had been able to enter into the mind of an expert intubator back then, or listen with more awareness when that expert held one up for demonstration, or if I had even been able to watch them in action with a more trained eye, then something else would have been revealed to me: that in experienced hands, the laryngoscope is something closer to an “all in one” multifunctional airway tool and not a simple “laryngoscope” at all!

This is because the process of intubation has three distinct phases (finding key anatomic landmarks, exposing the larynx, and delivering the endotracheal tube) and that in each of these phases the laryngoscope is manipulated in very different ways: hold it one way and it will help you find those essential landmarks, control the tongue, and deftly maneuver within the oropharynx. Hold it another way and it can help you take advantage of key anatomic structures to expose the glottic opening, and then create sufficient space to deliver your endotracheal tube.

Early in my training, I’m not surprised I missed this. Back then, I was just trying to remember the “prepping for intubation” checklist that would gain me entry to the head of the bed – believing that my dogged focus on getting enough intubations would eventually confer upon me the status of expert. It wasn’t until much later, when I realized that a necessary part of becoming an expert was understanding the mental framework upon which their skill is built, that I reached a tipping point in my own intubation skills.

In the case of laryngoscopy, it turns out that if you want to think like an expert intubator, then it’s smarter to think of the name “laryngoscope” as something of a misnomer, because it doesn’t do justice the real power it has a multipurpose airway tool. Sadly, this  subtle understanding of the expert intubator remained lost in translation for me.

Some of the confusion about what a laryngoscope really is may also be historical, since the laryngoscope (as a tool to view the structures of the larynx for diagnostic purposes) was invented prior the invention of the laryngoscope(s) we use today to perform intubation. Some of the problem may simply come from the preconceived meaning embedded in the name laryngoscope itself.

Whatever the source of the confusion, the bottom line is this: novice intubators will still require plenty of practice, but that practice can be more informed if it has the benefit of the expert intubator’s mindset: that the laryngoscope is really an all in one epiglotto-valleculo-laryngo-tube delivery device, and it’s important to think of it as such (even if we still call it a laryngoscope).



Flipping Direct Laryngoscopy
Bundled resources and perspectives on this topic from all over the FOAM universe in an easy to use format

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To view this resource click here or on the magazine’s image to the left. You can also follow more Protected Airway magazines here on Flipboard

For the best view we recommend downloading the mobile app

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Rapid Sequence Intubation

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Intubation & the Critically Ill Patient

The intersection of critically ill physiology and endotracheal intubation is a dangerous one: we can quickly turn a problem into a disaster if we focus only on the mechanics of the intubation, and fail to prepare for the effects this procedure will have on our patients.

DL versus VL – The Laryngoscopy Wars

Hey, it’s a partisan world out there, and change isn’t always easy. VL may not have killed DL as many proclaim, it has at least given it a good reason to worry for its survival in the coming years.

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Enter the Vortex

The Vortex Approach is airway education innovation and design at its finest. Train to prioritize oxygenation over intubation in any stressful emergency airway situation.

It’s More than Just a “Laryngoscope”

Before you pick up that laryngoscope read this to inform your practice with an expert mindset that can make your intubation skills better.

FONA and the Failed Airway

Zen mind, Cric mind. Deep knowledge for successful management of the failed airway.

Smart Laryngoscopy

If you want to build a successful approach to laryngoscopy. You a strong mental model for problem=solving. Check out Dr Levitan’s “smart airway” approach here.

The Bag Valve Mask

Arguably more important than intubation, the most under appreciated skill in airway management

O’s Up the Nose! #NoDesat

This topic is so important #NoDesat has become an airway meme on Twitter. This teaching module is dedicated to strategies for preoxygenation and the prevention of desaturation during intubation.

Supraglottic Airway Devices

Supraglottic airway devices are an often overlooked tool in emergency airway management. Here is why you should make the SGA your best friend!

Flipping the Airway

There’ so much good FOAM airway content it’s hard to bring it all together. Here is our solution: a beautifully designed platform called Flipboard to bundle curated content all in one place. We think you’ll agree it’s one of the best ways to collect, share, and enjoy this material.

What is the Protected Airway?

For those who want to learn effective emergency airway management strategies, The Protected Airway is learning build for humans. Click here to find out what we mean…

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