Intubation-How to perform endotracheal intubation # 2

[ninjaraph]

damn he's quick

[searrss]

Yup. ER docs can do this in their sleep. Pro.

[ctsugarcraft]

it's suck using that thing..i been using that for 4 month in a coma..

[mjolz]

yuh absolutely right fideree

[SoonKyu515]

it's amazing! how did he do that so fast..?

[drjctmd]

How fast he is!

[ransisua]

fuck, that's so freakin fast.

[JihadJerry623]

Not a detailed explanation. nothing about landmarks, technique of laryngyscope blade insertion, no cautions to take. Look further if you're new

[kisstimone]

A real physican or nurse would know better than wearing a watch while in conntact with care taker, siggh.

[reglap2002]

arte nyo panoorin nyo nlng mga tsong go

[Me6is]

that was really fast Good.

[jessrocked]

thats one great dummy

[docnextdoor]

No its not that ez. The patient's been knocked out with midazolam and patalysed with vacuro / fenta .

[docnextdoor]

No its not that ez. The patint's been knocked out with midazolam and patalysed with vacuro / fenta

[lenbot]

He states he visualizes vocal cords, but I think that isn't correct, and the second person looks kinda like a dummy

[itubeo1o]

he is not supposed to have his watch on!! lol

[Me6is]

@itubeo1o

I think it is a great idea to have a watch if you are the one putting people to sleep. They have to keep the correct time, it might be seconds??? when making people breathing in the drugs to put the to sleep... Even after this was done, the patient have to breath more gas... to long might kill the patient, to short might make him wake up during the surgery.

[genabell29]

wheres the tongue sweep? I've never seen anyone who can just throw a tube down there without getting the tongue out of the way first. For the guy who said LMAs are not used for surgery, they most certainly are, you cannot use muscle relaxants such as nimbex or zemuron or sux, but LMAs are commonly used for surgeries and are the way to go if possible. However, most surgeons require muscle relaxants to attain access to the area they wish to work on, so we have to intubate.

[lenbot]

@genabell29 not a hundred perecent sure but that little tool he uses pushes the toungue to the left side and holds it their while he is pressing

[gose99]

seems so easy ... let's see if he can intubate as fast in the middle of the street on a patient trapped in the car ... we learn the techniques in easy mode, no one tells us how is on the street , unfortunately

[AletaAntifascista]

i'm glad, we don't have to perform that in austria as paramedics...

[petahawk]

@AletaAntifascista

because in austria you are no paramedics

[jtube52]

the assistant who hands the ET tube to the clinician is not wearing any gloves... how sanitary is that?

[mtrance86]

@jlh945

honestly maybe you should've spoken to your anaesthetist.

the meds they use to put the patient to sleep also depresses the respiratory centre, and respiratory muscles thus they need to intubate them to allow adequate oxygenation via. artificial ventilation.

and bag valve mask and LMAs are not used for surgery as there is a risk of aspiration.

[sfenou]

@jlh945 In general anaesthesia they use medication that relaxes patient's muscles, including respiratory muscles, so a patient is not able to breathe on his own during surgery, that's why they do intubation -- it is artificial ventilation. It is crucial.

[cedriclee11]

i had i question im in emt-basis now and im learning how to do this how do they get it in the trache and not the esophagous without even really looking??? not trying to diss her but it hardly looked like she was looking she probably is just really good

[bonakid22222]

this tube gave me a sore throat when i woke up :(

[mimundo12u]

haaaaaaaaa!!!!!!!!!!! maldito salvajeeeeeeeeee su tecnica es muy brusca.....

[rafaelpresidente1]

Te felicito, me gusta tu técnica y habilidad para intubar, una pregunta es muy necesario poner una almohadilla de 10 cm en el occipucio para alinear los tres ejes, yo generalmente no la uso, un saludo desde México.

[Max0r92]

sauberes ding, respekt!

[fideree]

the doc was great...he's fast and accurate...not messy like others

[TheEmmausRoad]

@jlh945 - For whatever reason the patient will be paralysed and unable to breath for themselves, thus will have to be attached to a machine to breath for them. There can be many reasons why this is neccessary. The anaesthetist will give a reversable paralysing drug throughout the proceedure. It can be neccessary due to the kind of operation and/or the kind of anaesthetic.

Hope this helps.

[MOTHMAN225]

thank u for posting this. The doc's good, fast, and too the point.

[fireflyserenity84]

You need a direct line of O2 to the Lungs, and when the patients is in arrest or other

[encolpio1982]

tYou need o control ventilation and protect upper airway of the patient

[Yasfir83]

Muy buena tecnica,mas cuando no se cuenta con asistente

[pressstart88]

nice watch :)

[BipChannel]

is he dead?! :|

and yes i think it is a Mac... the miller series is usally used with asian / korian becuse of thayre face built

[krzymorek]

The narrator is Polish, isn't he?

[mrabbit10]

Obviously very skilled and a good video. but in regards to tpvalley's comments about wearing a watch in theatre... TP perhaps doesn't have a medical background but he was making a very good point about wearing a watch in theatre. sterile? clean? It's neither! Just a tad arrogant... anaesthetists transfer microorganisms as well - even the really skilled ones o:

[ColinMeloy91]

WOW! he's fast and good! is he usuing a macintosh laryngescope? (make sure you dont hit the epiglotis)

[QuestioningMySanity]

yep, that appears to be a macintosh. nicely done, tho. pretty quick procedure. but you can still come across some who are pretty hard to intubate that quickly.

[FutureRN0019]

great video

[NONSTEMI]

tp chill, those not in the sterile field need not to be sterile, l don't know if u r a med related, but seriously dude, inform yourself a bit prior to making such comments...

[tpvalley]

the surgion had his watch on!?

a watch on during an operation?!!!

Surely thats an infection source?

[digitalis112]

He is an anaesthetist, not a surgeon.

[tpvalley]

point is a watch is a terribly un-sterile thing, loads of bacteria!

He has gloves and all that, but a bloody watch!! madness!

[digitalis112]

The point I was making, that you clearly missed, was that he does not have to be sterile as an anaesthetist.

Those gloves aren't sterile. It's hardly like he is rubbing the watch into the guys mouth, is it? Besides, every time he touches a surface, the anaesthetic machine, his stool, his clothes, his bleep, the phone he will be inoculating his hands. You can't win!

[tpvalley]

anyone in the theatre must be steril and all equipment will be including gloves, if they touch their phone etc they change gloves, the machines r sterile also, along with the surfaces and his aprons.

[digitalis112]

I'm a medical student doing surgery. There is a clear divide in theatre between the sterile field and non sterile areas. If everyones sterile, who do you think ties my gown for me? Oh wait! The UNSCRUBBED and UNSTERILE scrub nurse!

When I'm not scrubbed, I can touch my dirty pen, answer the phone, have a scratch...whatever I like (apart from the sterile field obviously).

Best not to comment on things you don't know about :)

[tpvalley]

I donte believe u.

the nurse tying ur scrubs will have washed her hands, using her elbows to turn on taps, then she ties ur scrubs.

U seriously think the anaesthatist doesnt need to be sterile and wearing a watch is ok in theatre?

If u r a doctor god forbid u dont come across mrsa.

[digitalis112]

Don't be so silly. Firstly, it would be the gown, not the scrubs. Secondly, there is a major difference between being CLEAN and STERILE. Those gloves are CLEAN but not STERILE.

I know perfectly well about MRSA and I can tell you for a fact that MRSA didn't come about due to lack of cleanliness...it came about due to overprescription of antibiotics in healthcare and not helped by patients not completing full courses of antibiotics, leading to resistance. Go read up about bacterial resistance.

[whittvet]

not a surgion

[hasshot]

hay...perfectly done

but dont assume that the pt in ER or ICU will be as easy as this pt since this pt is paralysed and ever thing will be open widly.. pt any way this anasthatest is excellant and i pit that he can intubate this pt blindly

[RottenAnatomy]

the video was sped up in the beginning, that's why it looks so fast

[gblespaul]

Never remove laryngscope that fast, carefully withdraw making sure no contact with teeth. If patient was awake 1 move of the head and your hitting teeth. Also insert tube slowly, cords with be open at inspiration.

[hasshot]

he is fast but the techniqu of rmoval is perfect and will not injure the pt. im always removing the laryngoscpe by this way and it is really fast, effective and safe... because you will remove the laryngeoscope in curved way.. of course i m talking about paralysed pt.

[mill2mac3]

Just curious gblespaul, do you regularly use a MAC blade on an awake patient?

[four4vizslas]

I think this video was better than some of the other ones because the instructions match what is currently being viewed.

It is also better than many others is that they do give a good narration telling what the operator is doing!

[pochlomin]

thanks

[psychocloud]

Excellent technique!

[satinskyent]

get instruments

[medic70648]

Wow... this guy is the wind beneath my wings... he's so quick, makes it look so easy, lol.

[minimin3rva]

the laryngoscope should never come in contact with the teeth

[psychocloud]

He did not use the teeth as a fulcrum, nor did he slam the blade on the teeth. The teeth just merely rested on the blade. However, you're right, the teeth should never come in contact with the blade to avoid dental injury.

[tpvalley]

what was he inflating?

does the tube have a ballon on end to secure it like a cathata?

[psychocloud]

Yeah it has a balloon on the end to secure it. However, doctors and medics use a securing device as well like a shoelace or a commercial device.

[J999ACK]

Absoulutely! The Endotracheal tube does have a "Balloon" on it, to secure that no air escapes back up the wind pipe, and to secure the tube within the bronchus.

[QuestioningMySanity]

there is a cuff at the distal end which secures the tube in the trachea and keeps air from coming back up. there is a thin tube that runs down to the cuff, which is where he was putting the air into. there is a small balloon near where the syring is put in. when the distal cuff is fully inflated, the small balloon will be inflated.

[ebalel]

Notice he rests the laryngoscope on the upper teeth. He should give Dentasafe a try and avoid scrapping up against patients teeth, potentially harming them.

[rickey5353]

That guy must have run a Three Card Monte gig before entering medical school. LOL! "That'll be $1,700.00 Please!!

[marineslvr4646]

yeah....im in paramedic school right now....he makes it look realllllly easy....but i would like to see him do it that fast and easy upsidedown in a carwreck....not so easy then!!!! just sayin!

[jzm3bsj]

@marineslvr4646

Haha but I'd like it even more to see a paramedic do it upside down in a car crash! These anesthetic doctors do this all day, every day, and no one will beat them. Great skill!!

[theerealrocknrolla]

@marineslvr4646 yeah, my partner and I had a call like that and he intubated the person in the scenario you just described. It was pretty badass. He's a really good medic.

[Phishyness]

@marineslvr4646

I got mad respect for paramedics, but this guy is an anesthesiologist. These guys are airway specialists. I'm an RT and I've seen them do some crazy intubations Just sayin!

[jessrocked]

@marineslvr4646 its just a dummy.. in a real situation, patients usually close their mouth forcefully

[125maverick]

@marineslvr4646 either that or bouncing down the freeway going 90 mph

[m3gro]

@marineslvr4646 Actually im in paramedic training and a paramedic would do an intubation on a patient upside down in a carwreck... just saying

[meriamu2]

"slowly" ...haha...oh my gd...tomorrow ill have an operation with intubation... hope they'll gonna do it more softly...

[nicebut670]

Well i'd sooner have him do it quickly than fart around and leave me braindead due to lack of oxygenation.Mind you alot of my mates think braindeath might make me more intelligent.

[humdiddy15]

They preoxygenate you as to supersaturate with O2 so you won't die from any hypoxia...In the O.R. you have up to 6 min before entering an emergency algorithm for Airway...This was very fast and very gentle as opposed to some vids that I have seen...

[firstinlastout]

now try that moving at 45 mpg down a bumpy road with the patient's oral cavity full of blood ! Welcome to my world....

[kornizzkool]

had to do it in the rain the other week...not fun, OR is waaaaay easier, you can bring the pt to your level, adjust the head, you got a RN holding cricoid pressure, a tech handing you the tube and taking the scope.

[kimchijeegeah2]

honestly medics need to get paid more...

[mangoomuffin]

I was very fast too when I was young man. Now , its very hard for me to get my instrument hard before inserting in the hole.

Dr. Gore

[LamenessFTW]

when you watch medical videos its easy to understand why a patient feels so much pain after a surgery. They aren't exactly gentle sometimes.

[tubeahmed33]

very good and professional method,because really the entubation big task,especially in emergency cases.

Dr Ahmed

[mmlkoire]

This is a variant of so called "SCISSOR TECHNIQUE" a really good one for intubation.

I love the part where he says "Now u slowly insert the scope......."

[mamas1267]

Would be nice to know what number the tube was at the teeth...oh yeah and how dare him not call out the landmarks...what nerve ...i actually just wanted to hear him say "UVULA".lol

[yooper2]

ah he took his hand off the tube. that would fail for EMT-Bs at OFA. lol

[ibolit]

DAMN! He's fast!

[michaellovesthecat]

wow dont know how i stumbled on this but hey shout out to all the docters for there work have ablessed day To say the least thank you

[pimpinitfreely3]

LOL that was some fastttt intubation

[wwwalker2001]

Very helpful straight-forward video. Thank you. I was interested to see the intubator using his hip to manipulate the head to optimize visualization of the airway.

[BostonFenian]

Good God that is that fastest intubation I've ever seen. That is pro right there. I like how he says "slowly insert" but he drops it in there like it's nothing haha! Great vid

[ludachris1999]

thank you! thats exactly what i was thinking when he said that, i said " como que slowly" lol....

[johncolv]

It would be uncomfortable, except that usually they give you a sleep dose combination of sedative , muscle relaxant strong anagesic and perhaps volatile agent and laughing gas. Ususally enough to slug any hippo.

Hope your reassured.

[emeraldking18]

Yeesh. Having a tube in my mouth would be uncomftorable.

[MAnuciao79]

I wonder why they never take a look, before they put the tube in...

[mezzmac123]

He is looking - you can see using the Laryngoscope, it has a light attached and has a gutter which guides the tube into place. They should be able to see down to the vocal cords in the larynx prior to insertion.

[lapuntadelfin]

Hmm....... the combination of vocal chords and insertion. Memories are made of such things

[RobLeepopart]

a highly skilled anesthetist

[tubeahmed33]

yes I agree 100%, I am trying to applt it my self in case of emergency

Dr Ahmed

[VALDIRVAVA]

OOOPS - Esophagus......

[hankydoodle92]

I hope this guy gave his permisson to be on youtube:P

is the covering to not show his identity or to show that he is awake.. joke