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Techniques for Nasal Intubation

Teaching Anatomy

Emergency airway management requires a thorough understanding of laryngeal anatomy; when landmarks are partially exposed due to a difficult airway, or distorted by pathology, or complicated by blood, secretions, or vomitus, the operator still needs to be able to successfully achieve endotracheal intubation. Confidence and speed in recognizing anatomic landmarks become even more important in situations of short safe apnea times, rapid sequence intubation, etc., and other time pressures common to emergency airways.

 

Airway drawings and plastic mannequins afford an opportunity to review the relationships of different anatomic landmarks, but it is necessary to look at real tissue to truly train your eyes. Drawings can effectively demonstrate important airway anatomy principles, such as the laryngeal inlet, and how a line of sight during laryngoscopy progressively exposes different structures.

 

Read More about the Laryngeal Inlet

 

For real tissue visual training a myriad of airway devices now provide airway imaging. This includes fiberoptic endoscopes, Airway Cam imaging of direct laryngoscopy, and video laryngoscopes. Laryngologists use strobsocsopy to examine voice function and this gives a remarkable view of the inner larynx. Click on links below for specific devices; a full video library of airway and intubation imaging is now available on this website (go to Video Library tab above)

 

Fiberoptic nasoendoscopy and fiberoptic intubation:

Nasoendoscopy Anatomy

Fiberoptic Nasal Intubation

Fiberoptic Oral Techniques

Flexible Fiberoptic Instruments

 

Airway Cam Imaging of Direct Laryngoscopy

 

Video laryngoscopes:

Glidescope Anatomy

Rigid video laryngoscope

 

Stroboscopy

 

Anatomy investigation is best done in cadavers. This setting permits unlimited time and procedural training without clinical risks to the patient. Opportunities for cadaver airway procedural training are very limited, but there is a regularly offered (monthly) course that provides 18 bodies specifically prepared to ensure good tissue turgor and flexibility. This is a truly unique airway course offered only in Baltimore MD, and run by Dr. Levitan. Click Here for more information

 

Another one of a kind course for practitioners seeking a real tissue experience is the Norwich Endoscopy Airway Training Course, offered regularly in the UK. This course involves participants performing endoscopy on each other, including fiberoptic intubation.

Click Here for more Information

 

There are some risks to fiberoptic intubation, even in healthy volunteers in this monitored setting. The Norwich Course experience has been reported here:

N. M. Woodall, R. J. Harwood and G. L. Barker .  Complications of awake fibreoptic intubation without sedation in 200 healthy anaesthetists attending a training course. British Journal of Anaesthesia 2008 100(6):850-855.

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DISCLAIMER:  The procedures discussed at this website, to be performed properly, rely on complex medical skills and should only be undertaken after formal instruction and hands-on clinical training with appropriate supervision, and after receiving professional certification and authorization to do so. The content presented herein is meant to serve as just one of many resources that trainees and health care professionals should consult in the course of the their skill acquisition and ongoing practice. Airway Cam Technologies, Inc., its authors, officers, agents and assigns, disclaim any and all responsibility for any adverse outcomes and or harmful acts committed by others persons who may have consulted this website or relied on information contained herein.

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