It’s been a while so there has been a couple of great articles and podcasts about airway subject just in time for our sim practice!
On our previous basic airway session, we talked about the importance of;
- two hands technique
- slow and gentle ventilation
Three prehospital specialist physicians from Sydney Great Area HEMS are hammering in these important skills in their blog ‘Prehospital Basic Airway & Oxygenation‘ so check it out!
…I’m not quite sure about how docs keep calling RSI and other advanced interventions ‘sexy’…lol, it still is a great podcast!
We also talked about ‘Head Rotation for Mask Ventilation’
Ramped vs Sniffing position
As a big fan of EmCrit, I’ve routinely used our stretcher to raise patient’s head (with towels, blankets) for the ramping effects, for the purpose of improving the laryngoscopic view and reducing the risk of critical desaturation.
Then, the study in March (Semler et al., 2017) concluded the ramped position, compared to the sniffing position, may worsen glottic view and increase the number of laryngoscopy attempts required for successful intubation.
And this is the great analysis of the article titled ‘CC Nerd- The case of the Anatomic Inaccuracy‘ by .
Please read the article and the analysis so you can be the judge yourselves, but the key take home point for me is to still think about the ‘External auditory meatus (ear) to the sternal notch alignment’. And most importantly, in case for paramedics, we may need to use our boots, car’s headrest, or whatever works to achieve the position, but DO IT WELL and focus on the important things such as avoidance of critical hypoxia and hypotention, as suggested by
Collins, J. S., Lemmens, H. J. M., Brodsky, J. B., Brock-Utne, J. G., & Levitan, R. M. (2004). Laryngoscopy and Morbid Obesity: a Comparison of the “Sniff” and “Ramped” Positions. Obesity Surgery, 14(9), 1171–1175. https://doi.org/10.1381/0960892042386869
Lebowitz, P. W., Shay, H., Straker, T., Rubin, D., & Bodner, S. (2012). Shoulder and head elevation improves laryngoscopic view for tracheal intubation in nonobese as well as obese individuals. Journal of Clinical Anesthesia, 24(2), 104–108. https://doi.org/10.1016/j.jclinane.2011.06.015
Semler, M. W., Janz, D. R., Russell, D. W., Casey, J. D., Lentz, R. J., Zouk, A. N., … Rice, T. W. (2017). A multicenter, randomized trial of ramped position versus sniffing position during endotracheal intubation of critically ill adults. Chest. https://doi.org/10.1016/j.chest.2017.03.061