A. PLACEMENT
Anatomical Stepwise Navigation for Laryngoscopy
Follow a structured approach during laryngoscopy to guide your intubation: EVLI
Epiglottoscopy (± Uvuloscopy)
- Visualize the epiglottis to locate the airway opening.
- In difficult cases, identifying the uvula can help orientate you.
Valleculoscopy
- Position the tip of the laryngoscope blade in the vallecula (the space between the tongue base and epiglottis).
Laryngoscopy
- Visualize the vocal cords by lifting the epiglottis.
Intubation
- Pass the endotracheal tube through the vocal cords into the trachea.
Technique Tips
i. Bimanual Laryngoscopy (External Laryngeal Manipulation)
- Applying external pressure to the larynx to improve visualization of the glottis.
- This is preferable than traditional BURP (Backward, Upward, Rightward Pressure) maneuver, as it provides better precision in optimizing the view.
ii. Troubleshooting Tube Placement:
- Laryngeal Hang-up
- Difficulty passing the tube through the vocal cords:
- Rotate the tube 90° to the left.
- Difficulty passing the tube through the vocal cords:
- Tracheal Hang-up:
- Difficulty passing the tube into the trachea:
- Rotate the tube 90° to the right.
- Difficulty passing the tube into the trachea:
REMEMBER: Larynx = Left, Ring (trachea) = Right
B. Confirmation of Placement
Standard Confirmation Tool
- Capnography: The gold standard for confirming proper tube placement is by measuring end-tidal CO2 (EtCO2). The presence of sustained CO2 readings indicates correct tracheal placement.
Other Methods:
- Direct visualization: Ensure the vocal cords are between the double black lines marked on the ET tube.
- 5-point auscultation: Auscultate over both lungs and the epigastrium to rule out esophageal intubation and confirm bilateral breath sounds.
- Equal and symmetrical chest rise: Observe chest movement during bag ventilation to confirm proper tube placement.