A while ago, I posted videos of the method I use to change an intubating laryngeal airway (AirQ, Igel, etc.) for an endotracheal tube. But what if there is a non-intubating laryngeal airway or one with a crossbar in place? Well if you have a disposable bronch, then you can use this method from Erik Laurin and Will Rosenblatt.
Erik Laurin is an EM doc who came up with a way to exchange an SGA to a tracheal tube. Erik’s technique was beautiful, but can only be accomplished with the Ambu aScope (that is, if you want to keep your job). He spoke to Will Rosenblatt about the method. Dr. Rosenblatt is an anesthesiologist, an airway guru, and creator of the amazing AirwayOnDemand video site. Erik wanted Dr. Rosenblatt to try it out on a mannequin, but he declined – mannequin studies are close to worthless in his book. Instead Dr. Rosenblatt found the right elective case. This week he had a pre-op “cannot be ventilated patient” — that is, a patient with a deformity which would not safely allow the use of a face mask. He consented her to videography and described how he was going to handle her airway.
I hope you will find the Rosenblatt-Laruin described STaS (Sacrifice the aScope) maneuver useful and a little bit funny – it’s a real “duh” moment. This is similar to other discussions of a cut aScope filling in for the absence of an Aintree. However, this is the first
published filmed version of this technique that I have come across. A case report describing a similar technique was previously published by Chatterjee et al. (Chatterjee J,Reid C , Lewis A. Anaesth Intensive Care. 2012 Jul;40(4):724–thanks Minh). Dr. Rosenblatt hopes viewers will appreciate that this was their first (but not last!) use of the technique.
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020
- EMCrit Wee – Stop Kneejerk Intubation with the EMCrit Crew - March 30, 2020