Post Three of Janu-Airway
I just finished teaching at one of the best airway courses I have ever participated in (well actually, it's been a few months now). The highlight of the course was meeting Prof. George Kovacs. He has been obsessed with airway for decades. I picked up a number of great tips from him and I'm sharing those tips with you today.
Anesthesia for Awake Intubation
See this lecture to understand the intricacies of Awake Intubation
- EZ Atomizer
- George uses 15 ml of Lidocaine 4% in the EZ atomizer
- 5% Paste on a Tongue Depressor
- 10% lidocaine would be wonderful to spray down the cords (not available in USA)
Not Seating Fully in the Vallecula
The Move: Lift the Head
Bagging Grip
Underhand grip, like you are holding a football
How to Build Direct Laryngoscopy Muscles
Residents don't lift enough
Two-Hand Lift
Lock and Load and Potato Sacks
the following video demonstrates all of the best-look laryngoscopy techniques we have discussed thus far:
VL/Long Scope Combo and the Triple Set-Up
- Video Laryngoscope
- Fiberoptic Scope
- Surgical Airway Supplies
Effect of Dynamic Versus Stylet-Guided Intubation on First-Attempt Success in Difficult Airways Undergoing Glidescope Laryngoscopy: A Randomized Controlled Trial. Anesth Analg. 2019 Mar 7. doi: 10.1213/ANE.0000000000004102.
How to ask for In-Line Stabilization
- Take Off the Collar!
- Ear-Muffs Approach to prevent obstruction of jaw mobility
Automation Addiction
The FAA Report and its ramifications for Crit Care Airway Management
Want More from George?
- Procedural Skills in Medicine (pdf)
- George's Talk on Human and Psychological Factors in Airway Management From EM London
- Airway in a Minute Videos on George Kovacs Youtube Channel
- AIME Airway Site
- Airway Management in Emergencies Monograph
- George's EMCrit Guest Post on Antifragility
Additional New Information
More on EMCrit
- EMCrit 299 – Bougie Masterclass with George Kovacs(Opens in a new browser tab)
- EMCrit 194 – Definitive Emergent Awake Intubation with George Kovacs(Opens in a new browser tab)
- EMCrit 236 – George Kovacs on EVLI Airway Incrementalization(Opens in a new browser tab)
- EMCrit 253 – Kovacs Kata to Optimize a Failing Laryngoscopy Attempt(Opens in a new browser tab)
Additional Resources
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Great podcast, thanks. When I was a pulmonary fellow one of my jobs was to perform upper airway anesthesia before bronchoscopy using an atomizer very similar to the EZ Atomizer. It worked great. You start by anesthetizing the tongue and the back of the throat. Then, you can gently and progressively insert the atomizer deeper and deeper into the upper airway, anesthetizing as you go. Eventually you can wind up fairly deep in the oropharynx. The tip of the atomizer is flexible, and can be pointed downwards to aim the lidocaine towards the vocal cords and trachea. The patient can… Read more »
Here is a video of George Kovacs actually getting this procedure done to himself yesterday during his AIME Advanced course in Halifax:
http://advancedparamedicine.ca/posts/aime-airway-topicalization/
(Posted with his permission)