Intubation Essentials with Dr. Alyssa Stoner and Dr. Gina Patel, Part 2 Airway Equipment
Jul 8, 2021
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Dr. Alyssa Stoner and Dr. Gina Patel discuss intubation essentials, focusing on benefits of microcuffed tubes, ideal tube insertion depth, blade options, and challenges of using fiber optic endoscope for nasal intubations. They share personal experiences and valuable insights for successful intubation techniques.
Microcuffed endotracheal tubes simplify sizing selection by eliminating smaller increments.
Video laryngoscopy aids glottic opening visualization, useful for teaching and challenging intubations.
Deep dives
Equipment for Intubation
This podcast episode focuses on the essentials of intubation, specifically discussing the equipment needed. The hosts interview Dr. Gina Patel and Dr. Alyssa Stoner, who discuss the advantages and disadvantages of using cuffed endotracheal tubes versus microcuffed endotracheal tubes. They explain that the microcuffed tubes have a thinner cuff that eliminates the need to account for smaller size increments when selecting the appropriate tube. They also discuss the differences in cuff placement between the two types of tubes and how it impacts ventilation in different scenarios. The episode explores the appropriate depth of insertion for endotracheal tubes and how to determine the correct size of the tube based on the patient's age and weight. They also cover the different types of laryngoscope blades, including the Miller blade, Macintosh blade, and the Wists-Hippel blade, and how they are used for different age groups and anatomical considerations.
Video Laryngoscopy and Nasal Intubation
The podcast episode delves into the use of video laryngoscopy as an alternative to direct laryngoscopy during intubation. The hosts explain that video laryngoscopy provides a visual aid to improve the view of the glottic opening, making it useful for teaching and as a rescue technique when direct visualization is challenging. They discuss the different setups of video laryngoscopy, including a camera on the handle of the laryngoscope blade or connected to a tower with a monitor for broader visibility. The episode also touches on the use of fiber optic endoscopes for nasal intubations, highlighting that it requires a high level of skill and expertise. They mention that anesthesia colleagues are often more experienced with nasal intubations, which are used for difficult airways or when a more stable airway is needed.
Considerations and Coordination
In this podcast episode, the hosts emphasize the importance of considering anatomical factors and individual comfort level when selecting the appropriate laryngoscope blade and technique. They explain that floppy epiglottis in infants may require the use of straight blades like the Miller blade, while older patients might benefit from curved blades like the Macintosh blade. They also mention the D blade, which is effective for patients wearing C-collars. The podcast discussion further highlights the need for coordination, skill, and equipment availability for successful nasal intubations using fiber optic endoscopes. The hosts stress the importance of time, preparation, and the involvement of experienced personnel in these high-risk airway procedures.
Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City. Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.
Objectives
The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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