Name:
ACA- Hung 4e- Tracheal Intubation Using Bullard™ Laryngoscope
Description:
ACA- Hung 4e- Tracheal Intubation Using Bullard™ Laryngoscope
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/b91039d4-c3f1-4af8-85cf-3ab1bd66352c/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=2Y5qWsDwpWjSHSwV%2BHG1NmwxhmmeqJeZ2CNbFTYxAZk%3D&st=2024-10-16T01%3A11%3A07Z&se=2024-10-16T05%3A16%3A07Z&sp=r
Duration:
T00H06M41S
Embed URL:
https://stream.cadmore.media/player/b91039d4-c3f1-4af8-85cf-3ab1bd66352c
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/b91039d4-c3f1-4af8-85cf-3ab1bd66352c/Tracheal Intubation Using Bullard Laryngoscope.mov?sv=2019-02-02&sr=c&sig=uIACch7i3ERmGwI6gkZV4HqoyGNOLysNXR55FI2KDOc%3D&st=2024-10-16T01%3A11%3A07Z&se=2024-10-16T03%3A16%3A07Z&sp=r
Upload Date:
2023-11-24T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Segment:1 Device.
The Bullard Laryngoscope is an indirect, rigid fiber optic laryngoscope. The blade is anatomically shaped and has three channels, a light bundle, a fiber optic image bundle, and a 3.7 millimeter working channel to accommodate a Luer-Lok syringe. The working channel can also be used for oxygen insufflation, suction, or the application of topical anesthesia using an epidural catheter.
Illumination is powered by a battery handle. An external light source is better suited, if a video camera is utilized. The eye piece on the Bullard scope has an integrated knob for a diopter adjustment, and it can be connected to a standard 35 millimeter video attachment, to display the image on a video monitor. The blade has a thickness of 6 millimeters, and this can be used in patients with a limited mouth opening.
A plastic blade extender can be attached to the distal tip of the laryngoscope, for additional length. This blade extender should be considered when the Bullard laryngoscope is used for large or tall patients. The endotracheal tube can be introduced freehand, with a malleable stylet, or with one of two types of dedicated stylets. The Bullard intubating stylet anchors directly to the Bullard laryngoscope and fits snugly against the posterior and inferior aspect of the Bullard blade.
The tracheal tube is loaded onto the stylet and advanced over the stylet into the trachea during intubation. The straight tipped, multifunctional stylet also attaches to the Bullard laryngoscope and fits against its inferior aspect. In contrast to the intubating stylet, this is longer, straight at its distal end, and tubular, in order to accommodate an intubation catheter over which the tracheal tube is advanced.
Segment:2 Preparation.
The device should be prepared with an anti-fogging solution, warm water immersion, or warming the device, using an external source of heat such as the Bair Hugger. It is our preference to use the freehand technique with a malleable stylet. A stylet is wiped with a petroleum based-lubricant, before placing it into an appropriately sized tracheal tube.
It is also our preference to bend the distal end of the tracheal tube to 90 degrees. Similar to trach light intubation, a reverse loading of the tracheal tube onto the stylet and soaking in warm saline will minimize the tip of the tube from hanging up while it is advanced into the trachea. To minimize the obstruction of the viewing channel, all the air from the tracheal tube cuff should be deflated prior to intubation.
Segment:3 Technique.
It is preferable to place the head and neck of the patient in a neutral position prior to intubation. As shown in this video fluoroscopy, the blade is introduced into the center of the mouth and maintained in a sagittal position at all times. The blade is then rotated around and behind the tongue. With the scope handle now vertical, the blade is allowed to gently drop against the posterior pharyngeal wall and then advanced in a caudad direction, before lifting it vertically so that the viewing channel is directly pointing at the glottic opening.
A clear view of the larynx should be obtained prior to intubation. Using the freehand technique, the tracheal tube is advanced through the right corner of the mouth into the oropharynx and then into the glottic opening. The tube is then advanced over the stylet into the glottis, by pushing it with the thumb. The tube is secured in place and the stylet removed.
After intubation, the Bullard laryngoscope should be removed from the patient by forward rotation of the scope out of the patient's mouth.
Segment:4 Trouble Shooting.
Like many of the rigid fiber optic scopes, secretions, fogging, and difficulty directing or advancing the endotracheal tube through the vocal folds are the major obstacles to successful intubation when using the Bullard.
Secretions can be dealt with by using suction prior to intubation or by attaching suction to the working channel. Fogging can be reduced by warming or applying an anti-fogging agent to the optical bundle immediately prior to use. In addition, use of the working channel to insufflate oxygen may also reduce fogging and the effect of secretions on the view.
Elevation of the epiglottis can frequently be further assisted by performing a mandibular thrust or pulling the tongue forward. If the operator chooses to use a video attachment, an external fiber optic light source is also recommended, although this entire assembly becomes rather bulky. A jaw lift will often elevate the epiglottis and create additional working space between the epiglottis and the posterior pharyngeal wall.
One of the biggest problems for most users is getting the tracheal tube and stylet assembly to move medially to the glottis. It is our experience that this problem can be minimized with a 90 degree bend at the distal end of the tube and keeping the tube to the right corner of the mouth as it enters the oral cavity.
Segment:5 Summary.
Because of the anatomically shaped design, the Bullard laryngoscope provides a good view of the glottis in situations where a conventional laryngoscope cannot. However, in order to have a successful intubation, it is important to prepare the patient, the device, and a styleted tracheal tube carefully prior to intubation. In addition, familiarity with the technique should be obtained in patients with relatively normal airway anatomy, so that confidence is acquired and the benefits and limitations of specific devices are appreciated before using the device in patients with a difficult airway.
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