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Coda Change

Apr 25, 2017

Reuben Strayer presents a masterclass on airway management with laryngoscopy.

In the past two decades, airway management has been revolutionised by the development of video laryngoscopy, hyperangulated blade geometry, optical stylets, laryngeal masks, and a host of advances in airway pharmacology and technique.

The core skill of airway management, however, remains laryngoscopy. Reuben provides his take on how to perform this procedure with success.

Firstly, Reuben talks about positioning which is a critical step.

This includes the common mistakes made in patient positioning. Reuben shares a proposed set of parameters that the provider can use to guide positioning that is optimal for laryngoscopy. He also guides you through his take on the grip to use throughout the procedure.

Reuben talks about the effect of the grip on the operator’s catecholamine production and what to do to avoid excess catecholamine levels which will be detrimental to performance.

Next, Reuben confronts one of the core principles of RSI, the delay between medication administration and commencement of laryngoscopy.

He proposes an alternative approach that emphasises early laryngoscopy with deliberate slowness.

Reuben highlights the value of the jaw thrust – as performed by an assistant – during airway management. Then, he moves into a step-by-step analysis of laryngoscopy as the blade moves into the mouth, down the tongue and ultimately to the glottis.

Further, Reuben talks about the utility of suction.

This is an under-utilised device in his view. He discusses the two most important intra-laryngoscopy optimisation manoeuvres. First, optimisation of the position of the head and then, optimisation of the position of the larynx.

Reuben concludes by discussing the value of using the gum elastic bougie for both difficult and routine intubations and describe pitfalls encountered when using the bougie (and how to manage them).

In this presentation, Reuben Strayer breaks down laryngoscopy into its discrete components and describes best practice techniques at each step.

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