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:
Fiberoptic Nasal Intubation
Fiberoptic Oral Techniques
Flexible Fiberoptic Instruments
Airway Cam Imaging of Direct Laryngoscopy
Rigid video laryngoscope
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.