Equipment to have Bedside
- VL
- Suction
- New Same-Sized Empty ETT
- Additional ETTs
- Syringe
- Tube Exchanger (Cook CAE19 for ETT 7 or larger; CAE15 for ETT 5-6.5)
- BronchPort
- Tons of lube
- Bougie or Glidescope Stylet depending on your VL choice
- SGA and Scalpel
- ETCO2 with Waveform
- BVM
- If you have one available, a Bronchoscope is a wonderful bonus esp. if it can fit an Aintree catheter
A Video from AirwayOnDemand
Literature
- [cite source='pubmed']19299792[/cite]
- [cite source='pubmed']26111264[/cite]
Now on to the Wee…
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Scott Weingart
An ED Intensivist from NY. No conflicts of interest (coi).
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Can’t agree more with this post.
A common approach is to blindly exchange the ETT. This will almost always work, but occasionally will fail miserably. The failure rate is low enough that this method continues to be used and taught.
Changing out the ETT with under crystal-clear vision with VL seems safer. Sometimes this approach has been criticized as unnecessary. However, given a choice I’d rather be over-prepared.
Agree with Dr Farkas – my practice is always to have direct visualization of the procedure, whether using a bougie or exchange catheter device. Have seen one too many (one is enough!) times when the bougie has inadvertently been malpositioned into the esophagus when the old tube comes out.
Thanks for the great post!
Zaf Qasim
@emeddoc
Thanks for another great post!
I’ve never used an airway exchanger. We don’t have them at my service. I’ve had great success with the combination of VL (King Vision) and bougie.
Keep fighting the good fight, Scott.
Great talk – very important to address a seemingly easy situation which if not handled carefully may turn out as a disaster.
Remember “assumption is the mother of all f… ups
A few tips from my point of view:
Stage one should be preoxygenation – dial up the fio2
Turn up the sedation, analgesia and give relaxation before commencing any airway procedures. This may improve your view and blunted any effects of airway management, both hemodynamic and upper airway reactivity (laryngeal spasm)
absolutely! thanks, brother.