Intubation Morbidly Obese Mallampati III

[greenmctea]

It took her forever to advance the tube, she had a poor handle of what she was doing. Her circuit wasn't even ready to be connected. It's a good thing she had a glidescope, her airway skillz are shit

[pcfaulkner]

i concour

[Crishaana]

Amazing ! This is exactly what i needed to see !

[TheTatars]

the satisfaction is amazing..........



[ReviewCam]

do all obese patients require awake intubation?

[hantla]

@ReviewCam  no

[docnextdoor]

She fumbles with the ventilator tubings a bit too long

[sanjdgreat007]

are you anesthisiologist or workin on it?

[faguilin]

Definitivamente la presencia del glide scope ayuda mucho. Tal vez yo entraria con un fibrobroncoscopio y en un hospital donde no tenga a la mano ninguno lo haría posicionando mejor a la paciente (Ramp position) y ayudado con la maniobra de BURP

[sleepytimedoc]

pt is not optimally positioned for airway mgmt...needs a shoulder roll or two so mastoid process is aligned with sternal notch!

[1caninelover]

@sleepytimedoc Might need @ 200 les pounds on their body; morbidly obese patients are just a hooror to do any procedure on.

[Mrmoc7]

What a fat piece of shit. She should be executed.

[UFB85]

Hit the treadmills people! Obesity increases risks for virtually every health problem and makes most procedures more difficult

[paolocpp56]

The problem in obese patients very often isn't tracheal intubation but the inability of mask ventilation. If one can ventilate then work quite with an oxygenate patient.

[frmertd]

@paolocpp56 you are absolutely correct. This is why I always , in my pocket, keep an oral and nasal airway. Best to just have it in your pocket when you start so the RN's aren't fumbling around trying to find it.

question: why not , always, always always place a nasal airway before you start???? People don't do this but I think maybe we should. difficult bagging is extremely important and causes me more stress than not getting the tube in!

[paolocpp56]

@frmertd why not nasal airway before starting? Just not to give disconfort to the patient.

[henndri]

Good Video

[phillipngyn]

fat ass patient

[chopped50]

the gilde scope used in this vid makes you take you eyes off the cords and watch a screen,you have a light cord and light source too many parts.the mcgrath is better,no cords no light leads.racerunderthe sun all you do is bend the tube above the cuff into a hockey stick,the bend is the key.remeber your axis of sight has changed because you are looking at the cords through a curved camera.

[paramedicpantsrock]

ok that was cool!

[putitrightagain]

dear viewer, hold your breath for at least the duration of this video.

[gobblededo]

Yeah, it is pretty long, but hay, that's why you pre-oxygenate the patient before intubation!!

[aidanne07]

Why are some doctors so ruff,

[mam23mam2003]

very good .

but i need to ask u if we can insert tupe in mallmpati 3 with laryngoscope only

[drdar77]

y he used lta before intubation. it was not diffcult at all

[anestesiaperu]

buen video

[alidlid]

Apnea for 1 min.

Fastrach-intubating with spontaneous or controlated ventilation, could be a good option. I guess

[jrodskidoo]

judging by the angle of the laryngoscope blade and the normal curve on the styletted tube, and the subsequent ease of intubation, this person wouldn't have been difficult to intubate using a standard macintosh blade. Love how the circuit fell apart just before connecting up - happens to us all the time..

[suzygreenberg1]

If the airway is difficult enough to require a glidescope for intubation, why the hell would you waste time with an LTA kit prior to ETT insertion? Also, it sometimes helps to have a circuit put together at some point before you intubate. You know, for ventilation and such. This is why your anesthesiologist should not eat an entire bag of mushrooms on the way to work.

[Needledriver56]

Obviously meant to show the usefulness of glidescope. We have similar usefulness from McGrath. I like the adjustable blade on the McGrath. Not difficult to learn to use well.

[RacerUnderTheSon]

the McGrath got me out of a couple difficult situations... it can be hard to advance the ETT after inserting it into the glottis with the McGrath

[aburd33]

@RacerUnderTheSon

Mcgrath has bailed me out a time or two. Very nice device. . If your view of cords is perfect the scope needs to be retracted to where the epiglottic almost falls into view, Then advance. Had the Rep for the device come back after we bought one because our whole group was having same issue. It works. Sorry if you already had this info.

[RacerUnderTheSon]

the RAMP position is underutilized

[RacerUnderTheSon]

i wonder if the patient's SpO2 decreased significantly... a morbidly obese patient, supine, under general anesthesia will desaturate rapidly... pt went without ventilation for at least 1:21 min

[kittyasuka]

I agree I think it could have been done a bit faster.

[toenails80]

preoxygenation for a minimum of 3 mins prior to intubation will buy loads of time for o2 reserves - no worries

[RacerUnderTheSon]

i agree but only in healty pts with nl BMI. this pt will desaturate in less then 1 min, maybe 45 sec while supine. I've seen it many times.

[aburd33]

@RacerUnderTheSon

Agree, seen it thousands of times

Obese + Supine=

Biggest impact on FRC= Quick Desaturation

[NONSTEMI]

she got a bit confused at the end, trying to ventilate through CO2 detector :D also she shouldn't have waited all that long for tube insertion after she inserted blade

[Arthur54321]

A lot of arsing about with the circut at the end!

[peerah]

Nice job! Would have been nicer to start ventilating the patient right away after intubation but generally a good job.

[criticbo]

It looked like the vent circuit came off, all in all not too bad. I would prefer to have a bag seperate from the vent, in that case you could hav

[mixovirus]

In my opinion the flaw in this video is the critical time since the insertion of the ET tube and the ventilation, the practitioner hesitate in that process first wanted to connect the oxygen to the tube... hesitate and then had to disentangle the tubes of respirator! everything "must" be prepared for that procedure... and more if you are filming it, its my point of view. but is the reality when you are in that situation, in general its a good procedure.

[anestesal]

Esta persona que esta realizando es alguien con una técnica pobre ya que técnicamente es una laringoscopia de facil acceso, además de traumatizar la laringe de una forma exepcional introduce la canula como su fuese a un animal, uff que miedo. mala técnica laringoscopica, pesima colocacion de la paciente. triste video...

[passportrider]

Can you say "ischemic brain injury"?

[RacerUnderTheSon]

Wow, very poor positioning! Even if one anticipates intubating easily with a video laryngoscope, this patient should be positioned in the RAMP position.

[o2demand]

excellent clinical audio and video lecturs

great for medical students and residents

account: o2demand

website: o2demand

[Nap2DadeC]

Wow, making intubation looking severely easily. Can't wait for the day I start intubating patients like its a walk in the park...

[pittsburghdoc]

I personally like to emply the HELP (head elevated layrngoscopy position) position when instrumenting the airways of my morbidly obese patients.

[trainjustleft]

Pigs on vents. Your healthcare dollar at work.

[Penko83]

lol!!!

[celestessia]

I'm training on ACLS and I just found this video really practical at the moment of visualzing the whole proccess. Is there any other?

[drahcirtrauts]

ebalel - the arrogance of your comments is unhelpful and likely to turn people off your product- the appearance to me was of gentle pressure, and the only person who knows how much pressure was applied was the intubator himself! Your product may prevent enamel damage but will not prevent trauma to or loosening of implants from long-axis pressure. I suggest you use another forum to sell the things

[GasmanAM]

I'm very interested to know what the first introducer applied through the vocal cords was for.

[djdoylemd]

That was lidocaine (local anesthetic) sprayed around the glottic aperture prior to placing the tracheal tube. John Doyle.

[GasmanAM]

Do you know the name of this device, or who manufacters it? It looks like it is a breathing spontaneously technique. Is this the standard technique for a difficult airway? If so, which organisation has published the algorythm. Is fibreoptic intubation no longer used?

Sorry for so many questions. I am an anaesthetist in the UK and this is not a standard technique that we use here.

[djdoylemd]

The LTA 360 Kit (Abbott Laboratories, North Chicago, IL) consists of a semi-flexible, curved white cannula, 3 mm in diameter and 20 cm in length, fused to a 4-ml syringe filled with 4 ml lidocaine, 4%. A black mark 10.5 cm proximal to the distal tip provides a visual aid for the depth of insertion. With the black mark at the glottis, the multiple perforations in the cannula lie beneath the vocal cord and spray the trachea with topical anesthetic. See Anesthesiology, Volume 94 June 2001 p 1153

[djdoylemd]

Q: Is fibreoptic intubation no longer used? A: Fiberoptic intubation, especially done awake, remains popular in the USA. This video illustrates the Storz video laryngoscope and is very helpful in patients with a potentially difficult airway, such as very obese patients.

[GasmanAM]

Thank you very much for your help. Enjoy your day.