Name:
ACA- Hung 4e- Macintosh Laryngoscope
Description:
ACA- Hung 4e- Macintosh Laryngoscope
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/361f733e-327b-4a39-a872-7ab21139e452/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=v2wt6CGzRaJBKLA4UDOUTMjPrjT%2BpdjgtQnbU0BYpw8%3D&st=2025-05-09T11%3A14%3A24Z&se=2025-05-09T15%3A19%3A24Z&sp=r
Duration:
T00H04M04S
Embed URL:
https://stream.cadmore.media/player/361f733e-327b-4a39-a872-7ab21139e452
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/361f733e-327b-4a39-a872-7ab21139e452/Macintosh Laryngoscope.mov?sv=2019-02-02&sr=c&sig=Aoc5gIFckqfgh0eajtoSd154Iu2j4u8FTioQyyVeEH4%3D&st=2025-05-09T11%3A14%3A24Z&se=2025-05-09T13%3A19%3A24Z&sp=r
Upload Date:
2023-11-24T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Segment:1 Device.
The Macintosh laryngoscope has two parts-- a handle and a blade, which connect with a hook on fitting. Most contemporary Macintosh laryngoscope handles contain a battery and a bulb providing light conducting through a fiber light bundle to the distal end of the blade. The blade is designed to facilitate displacement and control the tongue.
The tip is designed to be placed in the vallecula to lift the epiglottis to expose the glottis.
Segment:2 Preparation.
The battery and the light source of the laryngoscope should be checked for optimal condition prior to its use. A proper size endotracheal tube should be selected. The cuff should be checked for leaks and must be completely deflated to avoid obscuring the glottis during intubation. In some situations, a well-lubricated malleable stylet may be necessary to stiffen and shape the tube as required.
Segment:3 Technique.
Denitrogenation of the patient is required prior to the intubating attempt. The patient's head and neck is placed in a sniffing position. The laryngoscope handle is held by the left hand, while the right hand is used to open the mouth to ensure that the lips and teeth are clear of the blade. The blade is slowly advanced to the base of the tongue, which is displaced to the left of the blade.
Once the epiglottis is identified, the tip of the blade is then advanced into the vallecula, and hyoepiglottic ligament is pressed. The laryngoscope is lifted gently to avoid damaging the upper dentition. If the epiglottis cannot be seen clearly, external pressure applied to the larynx can be used to improve the view. Once the glottis is visualized, the endotracheal tube is then introduced at the right corner of the mouth.
The endotracheal tube is then placed through the chords and advanced until the cuff passes beyond the cords. Correct placement of the tracheal tube should be confirmed by the presence of end-tidal CO2 and auscultation.
Segment:4 Trouble Shooting.
Despite proper patient evaluation, device preparation, and good intubating technique, laryngoscopic intubation remains difficult in 1% to 3% of the population. Optimal external laryngeal manipulation has been shown to consistently improve the laryngeal view as shown in this video.
The Eschmann tracheal introducer is particularly useful when only the epiglottis can be seen using a laryngoscope. Under these circumstances, the Eschmann introducer can be hooked underneath the epiglottis and advanced into the trachea. If it is correctly placed in the trachea, a subtle, tactile clicking sensation can be felt as the tip of the Eschmann introducer slides over the tracheal rings.
Failing to feel these clicks, the introducer can be gently advanced until a holdup is felt as the introducer is lodged in the distal bronchus. With the Eschmann introducer positioned at about 22 centimeters at the mouth, the tracheal tube can then be advanced over the Eschmann introducer into the trachea. To facilitate the advancement of the endotracheal tube over the Eschmann introducer and into the airway, the tongue and epiglottis must be elevated by a gentle jaw lift or, preferably, by the laryngoscope already in place.
Segment:5 Summary.
Tracheal intubation under direct laryngoscopy remains the gold standard technique and is generally easy to perform for most patients. However, successful intubation requires proper preparation of the patient and equipment, proper positioning of the patient's head and neck, as well as good intubating technique. Occasionally, a styleted endotracheal tube or a tracheal introducer may be required to facilitate the placement of the endotracheal tube in patients with a difficult laryngoscopy.
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