Where Will You Cut the Neck? POCUS Makes Perfect

Where Will You Cut the Neck? POCUS Makes Perfect

Practicing to find the midpoint of the cricothyroid membrane with ultrasound is a much better way to learn than by using only external landmarks and no ultrasound.

Bougie vs Stylet - The BEAM Trial

Bougie vs Stylet - The BEAM Trial

First attempt success was higher in the bougie group vs stylet group (98% vs 87% in all comers, 96% vs 82% in patients with at least one difficult airway characteristic). The median duration of the first-attempt as well as incidence of hypoxemia was similar between bougie and stylet groups.

GlideScope Not Easy to Use in Kids

GlideScope Not Easy to Use in Kids

The GlideScope in pediatric patients was not easy to use.  Experienced intubators had technical difficulty 58% of the time, most often just as the tube passed the cords.  Clockwise rotation helped passage.  You must practice with it before you use it on live patients.

Mallampati Score and Pediatric Sedation Risk

Mallampati Score and Pediatric Sedation Risk

Children needing deep sedation in the ED were not at greater risk for adverse events if they had Mallampati III/IV scores.  But they did need to be repositioned more often than children with Mallampati I/II scores.

People Are Not Using EtCO2 for ETT Confirmation?

People Are Not Using EtCO2 for ETT Confirmation?

This study showed 7% of doctors intubating children were not using any form of EtCO2 detection to confirm placement: waveform capnography or colorimetric.  This is appalling.  The point of the article was to encourage use of capnography, but a more important message is you must use some form of EtCO2 detection.

Don't BURP the Baby?

Don't BURP the Baby?

External laryngeal manipulation (ELM) was associated with reduced first-pass success in critically ill children requiring emergent intubation.  But it could have simply been a marker of a more difficult airway, not the cause.

Big Person? Big Dose of Succinylcholine

Big Person? Big Dose of Succinylcholine

Not surprisingly, heavier patients had lower first-pass endotracheal tube success.  They also had succinylcholine under-dosed more often. Give yourself the best chance for success and optimize muscle relaxation in obese patients.

Ear-Sternal Notch - How Should You Ramp?

Ear-Sternal Notch - How Should You Ramp?

We’ve all been taught to use the “sniffing position” when intubating patients in a supine position. However, when adding ramped positioning for pre-oxygenation and intubation, fidelity to the “sniffing position” degrades. A couple Australian anesthesiologists have written a letter to clarify the proper technique.

Should We Ditch Preintubation Checklists?

Should We Ditch Preintubation Checklists?

Calling out a verbal, pre-intubation checklist to make sure equipment was present and the intubation plan (and backup plan) was in place did not result in improved lowest oxygen saturation.  Read on to see why we shouldn't ditch the checklist just yet.

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