This post is a a summary of a portion of Dr Byrne's airway talk from last month's ResusEM conference at the Cooper Medical School of Rowan University. New techniques for preoxygenation before intubation can help to prolong time to desaturation and make this potentially dangerous procedure safer than ever!
Intubation has traditionally been performed with patients in the full supine position. Recent data suggests that elevation of the head of the bed may be more effective during preoxygenation before intubation. Check out this summary of a paper from Anesthesia that put this idea to the test!
You are intubating a sick patient in the ED via direct laryngoscopy. After opening the airway, sweeping the tongue with your blade, inserting into the vallecula, and lifting at the precisely correct angle your eyes behold....well...not the vocal cords! Maybe the arytenoid cartilages if you're lucky (aka Cormack Lehane 3 or 4 view). But wait, you aren't finished yet! You reach into your back pocket and remove your trusty bougie...