Newer model Vividtrac test with improvised bougie technique with Dr DuCanto
Jim uses the newly remodelled Vividtrac in a 144kg patient
Prehospital pointers and some general commentary:
1. Please note. A lot of Jim’s patients are elective fasted patients so issues of full stomach and blood and pus in airway are not often encountered. Preoxygenation with the Oxylator or a ventilator is a smart idea in these cases as you can limit the pressure and flow, thereby reducing gastric distension. Its much harder to do that with a manual BVM. Nasal cannula apnoeic oxygenation might help in these large patients during intubation as well but note how with adequate preoxygenation with Oxylator, the SpO2 does not fall below 80% during entire intubation.
2.Note the newer model Vividtrac provides an excellent view of the larynx, which is small and hence Jim has problems passing a 8.0 ETT via the guidechannel. A few things he could have done with an excellent laryngeal view but difficulty passing the tube.
A.use a bougie or in his case an improvised bougie ( esophageal temperature probe), like you would use it normally, and not via the guidechannel
B.use a styletted smaller size ETT in a straight to cuff , hockey stick shape, passing it independent of the Vividtrac which provides video guidance alone.
-Jim as always thinks faster than a supercomputer and solves his tube passage issue with a esophageal probe down the ETT whilst still in the guidechannel of the Vividtrac. This allows the larynx inlet to be negotiated due to smaller diameter of the probe. Brilliant maneuver, Jim!
I recommend A or B aforementioned for those lesser airway masters who dont want more excitement than necessary!