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SECTION II RESPIRATORY PROCEDURES

DIRECT LARYNGOSCOPY

Check all equipment, Place patient in the

1 including the light on 2 sniffing position,
the laryngoscope and elevate the bed so
the cuff on the that the patients
endotracheal tube. head is at the level
of the lower part
Ensure that suction and of your sternum,
difficult airway devices and preoxygenate.
are within reach.

Hold laryngoscope Push the tongue to

3 with your left hand. 4 the left side of the
Open patients mouth mouth, slowly
with your right hand advance the blade,
and introduce the and progressively
laryngoscope into the identify the base of
right side of the the tongue, the
patients mouth. epiglottis, and the
posterior cartilages.

Place the Macintosh Lift in the direction

5 blade in the vallecula, 6 of the laryngoscope
E or the Miller blade handle.
under the epiglottis (E),
and visualize the vocal Manipulate the
cords (VC) and thyroid cartilage to
arytenoid cartilages (A). achieve optimal
laryngeal exposure.
VC Do not take your eyes Have an assistant
off of the cords once maintain that
they are identified! position during
A intubation.

Instruct an assistant Under direct

7 to retract the right 8 visualization, pass
cheek for better the tube 34 cm
visualization. Pass beyond the vocal
the tube on the cords.
right side of the
patients mouth. Do
not allow the tube
to obstruct your
view of the vocal
cords during
advancement!

Remove the stylet Confirm proper

9 and inflate the 10 placement with
pilot balloon. end-tidal CO2
detection,
ausculation, and a
chest radiograph.

Figure 4-9 Direct laryngoscopy.