Skip to content

In war, he who holds the higher ground,wins

100_0088

Not ideal, read on and find out why!

Merry Xmas folks!

Ok some holiday reading

First here is the article

Higher operating tables provide better laryngeal views for tracheal intubation

Simple things help. Knowing the optimal height of the patients head in relation to your own body can help a difficult intubation become easier.

This article suggests that its more comfortable and you get a better laryngeal view if you have the patients head at your xiphoid process or nipple level.

Comfort is important as it means you dont get stressed. this is good.

I know of more than a few failed prehospital intubations as a result of the intubator not positioning the patient adequately including trying to intubate on the ground.

This is sometimes not possible to change but often it is! If you can move the patient to a better position, including off the ground to a height that suits you, then thats going to help you get first pass success.

 

7 Comments Post a comment
  1. …and 360 degree access.

    Seems obvious, but how many times have you seen people attempting to intubate in a crowded resus bay or ICU room – hampered by monitor cables, suction and O2 on either side, monitors placed behind them, airway trolley on the left hand side (not right) meaning instruments are passed across field of view.

    I believe that we can learn a LOT from the prehospital arena and apply them to ED/ICU.

    A standardised approach – not just the obvious, like ramping and position ear-to-sternum…but meticulous attention to :

    - patient at optimum height for laryngoscopy
    - airway equipment standardised across OT-ICU-ED
    - trolley placed on right side so airway kit passed with no disruption to view
    - bougie for all RSI, preloaded in Kiwi grip
    - 360 access to patient, with only ONE conduit of monitor cables/suction/O2 hindering access
    - monitors visible to operator

    etc etc

    And, of course, use of an RSI checklist – goes without saying!

    December 26, 2013
  2. …use a stool Seth.

    But I take your point – especially if patient needs to be ramped or table tilted head up.

    I wonder how Mr EM-Crit manages?

    December 26, 2013
    • Seth Trueger #

      in the middle of DL, it’s much easier/less disruptive of all the lines & tubes, to use my knees to adjust my height down, then to climb up a stool

      December 26, 2013
    • Use a stool to sit down ;)
      In fact it makes you comfortable in uncomfortable situations.

      December 29, 2013
  3. …but Seth, if you set up your resus room correctly, there should be a minimum of lines n tubes disrupting access.

    This is a real bugbear of mine – sure, there needs to be plumbing…but those tethers – IV, monitor cabling, suction, vent tubing should all be positioned a much out of the way as possible

    The feng shui of resus room planning. Gonna be talking about this at smaccGOLD….

    December 26, 2013
    • Seth Trueger #

      Even if we assume the equipment is all tidy (which will never happen in a sick/time-sensitive patient in an urban US ED) it’s still a fair amount of time to climb up on a stool or precisely drop a bed to the right height, whereas my knees work remarkable quickly and there’s a built-in feedback loop.

      December 26, 2013
  4. OK, OK – you can guddle around on your knees if you insist, Seth.

    But tell me you at least use a checklist whilst you are down there…

    December 26, 2013

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

DrGDH

Or "How I'm Learning to Stop Worrying and Love Emergency Medicine"

Pondering EM

One junior EM doc's journey through the curious world of Emergency Medicine...

rain0021

A great WordPress.com site

Genevieve's anthology

Writings to amuse, teach, inspire and entertain.

JR Paramedic

Prehospital and retrieval medicine blog

Prehospital and retrieval medicine blog

Keeweedoc

A topnotch WordPress.com site

BoringEM

Bringing the boring to emergency medicine

resusNautics

Navigating resuscitation

Doctor's bag

by Dr Edwin Kruys

Prehospital and retrieval medicine blog

Prehospital and retrieval medicine blog

ETM Course

Emergency Trauma Management Course

The Doctor's Dilemma

Modern Medical Musings from Dr Marlene Pearce

Sim and Choppers

A blog combining medical education, simulation and helicopter retrieval medicine

GreenGP

Reflections of a Rural GP

Auckland HEMS

Unofficial site for prehospital care providers of the Auckland HEMS service

Rural Doctors Net

useful resources for rural clinicians

expensivecare

Searching for the big picture in intensive care

Nomadic GP

Adventures of a Rural Locum

Follow

Get every new post delivered to your Inbox.

Join 5,856 other followers

%d bloggers like this: