How to use a laryngoscope
A Close-Up Look at Laryngoscopy
Sep 17, †Ј Direct Laryngoscopy. 1. Indirect Laryngoscopy. Indirect laryngoscopy is the easiest form. The doctor uses a light and small mirror to view into your throat. The mirror is 2. Direct Fiber-Optic Laryngoscopy. 3. Direct Laryngoscopy. Intended Use Starkling Laryngoscope is a two-part, hand held device consisting of a handle that contains batteries and a detachable blade. Laryngoscopes are designed to provide illumination within the larynx during the process of performing intubations. This .
This description is for a Macintosh laryngoscope curved blade in an adult patient based on the Levitan approach. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training how to use a laryngoscope biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in larynggoscope using translational simulation to improve patient care and the design of processes and systems at Alfred Health. On Twitter, he is precordialthump.
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OVERVIEW Direct laryngoscopy is the use of the laryngoscope to visualise the vocal cords larynx under direct vision, usually to facilitate endotracheal intubation. Left eyed laryngoscopists rotate their head slightly to the right, bringing the left eye closer to the target. Position the patient with ear-to-sternal notch alignment also known as the HELP aka Head Elevated Laryngoscopy Positioning either put pillows under the head or tilt the head of the bed up e.
Tip position not force is the main determinant of glottic exposure. External laryngeal manipulation may help help open up the vallecular space to allow the blade tip to be appropriately positioned If the epiglottis is not found use suction to clear secretions that pool in the posterior pharynx to obscure the epiglottis perform methodical midline advancement hkw the blade down the tongue which is a reliable way to find the epiglottis Laryngeal exposure Identify glottic structures the first glottic structures seen are the posterior cartilages arytenoids and interarytenoid notch, before the glottic opening and the vocal cords If the view of glottic structures is poor then: perform bimanual laryngoscopy: externally manipulate the thyroid cartilage to drive the tip of the blade into proper position in the valecula, which optimises the mechanics of indirect epiglottis elevation.
Get an larybgoscope to hold the larynx in position externally. Non Necessary cookies to view the content. Critical Care Compendium. Chris Nickson. His one great achievement is being the father of two amazing children.
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Х Using The Laryngoscope -McGRATHЃ X bladeЩ 21 2. Doc no: Revision B From Serial Number onwards Aircraft Medical Ltd likedatingall.com 1 Introduction Description The McGRATHЃ MAC Video Laryngoscope (McGRATHЃ MAC or the device) is a tool used to aid the intubation of the trachea. Apr 08, †Ј Video showing stepwise assembling of LaryngoscopeUseful for undergraduate students of MBBS for practicals and vivaonline medical books visit likedatingall.com Jan 01, †Ј Hold the laryngoscope correctly to provide maximum control and mechanical advantage. the laryngoscope handle should be gripped as low down as possible; Elbow should be kept close to the body; Epiglottoscopy. Open the mouth as wide as possible using a scissor technique. use the first and third digit for maximum mechanical advantage.
It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. Laryngoscopy may be performed to facilitate tracheal intubation during general anaesthesia or cardiopulmonary resuscitation or for surgical procedures on the larynx or other parts of the upper tracheobronchial tree. Direct laryngoscopy is carried out usually with the patient lying on his or her back; the laryngoscope is inserted into the mouth on the right side and flipped to the left to trap and move the tongue out of the line of sight, and, depending on the type of blade used, inserted either anterior or posterior to the epiglottis and then lifted with an upwards and forward motion "away from you and towards the roof ".
This move makes a view of the glottis possible. This procedure is done in an operation theatre with full preparation for resuscitative measures to deal with respiratory distress. There are at least ten different types of laryngoscope used for this procedure, each of which has a specialized use for the otolaryngologist and medical speech pathologist. This procedure is most often employed by anaesthetists for endotracheal intubation under general anaesthesia, but also in direct diagnostic laryngoscopy with biopsy.
It is extremely uncomfortable and is not typically performed on conscious patients , or on patients with an intact gag reflex. Indirect laryngoscopy is performed whenever the provider visualizes the patient's vocal cords by a means other than obtaining a direct line of sight e. For the purpose of intubation, this is facilitated by fiberoptic bronchoscopes, video laryngoscopes, fiberoptic stylets and mirror or prism optically-enhanced laryngoscopes. Some historians for example, Morell Mackenzie credit Benjamin Guy Babington Ч , who called his device the "glottiscope", with the invention of the laryngoscope.
He presented his findings at the Royal Society of London in All previous observations of the glottis and larynx had been performed under indirect vision using mirrors until 23 April , when Alfred Kirstein Ч of Germany first described direct visualization of the vocal cords. Kirstein performed the first direct laryngoscopy in Berlin, using an esophagoscope he had modified for this purpose; he called this device an autoscope.
In , Chevalier Jackson was the first to report a high rate of success for the use of direct laryngoscopy as a means to intubate the trachea. That same year, Henry Harrington Janeway Ч published results he had achieved using another new laryngoscope he had recently developed. With this in mind, he developed a laryngoscope designed for the sole purpose of tracheal intubation. Similar to Jackson's device, Janeway's instrument incorporated a distal light source.
Unique however was the inclusion of batteries within the handle, a central notch in the blade for maintaining the tracheal tube in the midline of the oropharynx during intubation, and a slight curve to the distal tip of the blade to help guide the tube through the glottis.
The success of this design led to its subsequent use in other types of surgery. Janeway was thus instrumental in popularizing the widespread use of direct laryngoscopy and tracheal intubation in the practice of anesthesiology.
The vast majority of tracheal intubations involve the use of a viewing instrument of one type or another. Since its introduction by Kirstein in ,  the conventional laryngoscope has been the most popular device used for this purpose. Today, the conventional laryngoscope consists of a handle containing batteries with a light source , and a set of interchangeable blades.
Early laryngoscopes used a straight "Magill Blade" , and this design is still the standard pattern veterinary laryngoscopes are based upon; however the blade is difficult to control in adult humans and can cause pressure on the vagus nerve , which can cause unexpected cardiac arrhythmias to spontaneously occur in adults.
Two basic styles of laryngoscope blade are currently commercially available: the curved blade and the straight blade. The Macintosh blade is the most widely used of the curved laryngoscope blades,  while the Miller blade  is the most popular style of straight blade.
There are many other styles of curved and straight blades e. These specialty blades are primarily designed for use by anesthetists , most commonly in the operating room. The Macintosh blade is positioned in the vallecula , anterior to the epiglottis , lifting it out of the visual pathway, while the Miller blade is positioned posterior to the epiglottis, trapping it while exposing the glottis and vocal folds.
Incorrect usage can cause trauma to the front incisors ; the correct technique is to displace the chin upwards and forward at the same time, not to use the blade as a lever with the teeth serving as the fulcrum. It is easier to visualize the glottis using these blades than the Macintosh blade in infants, due to the larger size of the epiglottis relative to that of the glottis.
Besides the conventional laryngoscopes, many other devices have been developed as alternatives to direct laryngoscopy. These include a number of indirect fiberoptic viewing laryngoscopes such as the flexible fiberoptic bronchoscope. The flexible fiberoptic bronchoscope or rhinoscope can be used for office-based diagnostics or for tracheal intubation.
The patient can remain conscious during the procedure, so that the vocal folds can be observed during phonation. Surgical instruments passed through the scope can be used for performing procedures such as biopsies of suspicious masses.
These instruments have become indispensable within the otolaryngology , pulmonology and anesthesia communities. Other available fiberoptic devices include the Bullard scope,  UpsherScope,   and the WuScope. The frequent failure of direct laryngoscopy to provide an adequate view for tracheal intubation led to the development of alternative devices such as the lighted stylet, and a number of indirect fiberoptic viewing laryngoscopes, such as the fiberscope , Bullard scope, Upsher scope, and the WuScope.
Though these devices can be effective alternatives to direct laryngoscopy, they each have certain limitations, and none of them is effective under all circumstances. One important limitation commonly associated with these devices is fogging of the lens. Jon Berall, a New York City internist and emergency medicine physician , designed the camera screen straight video laryngoscope in The first true video laryngoscope Glidescope was produced in and a production version with 60 degree angle, an onboard heater, and a custom screen was first sold in dec The true video laryngoscope has a camera on the blade with no intervening fiberoptic components.
The concept is important because it is simpler to produce and handle the resultant images from CMOS cameras. The integrated camera leads to a series of low cost variants that are not possible with the hybrid Fiberoptic units. In , the GlideScope designed by vascular and general surgeon John Allen Pacey became the first commercially available video laryngoscope.
It incorporates a high resolution digital camera, connected by a video cable to a high resolution LCD monitor. It can be used for tracheal intubation to provide controlled mechanical ventilation , as well as for removal of foreign bodies from the airway. GlideScope owes its superior results to a combination of five key factors:. In a study, the authors noted that the GlideScope provided adequate vision of the glottis Cormack and Lehane grade I-II   even when the oral, pharyngeal and laryngeal axes could not be optimally aligned due to the presence of a cervical collar.
Despite this significant limitation, the average time to intubate the trachea with the GlideScope was only 38 seconds. The Cobalt series of GlideScope then introduced a single-use variant that encompasses weights from grams to morbid obesity and is successful in many airway syndromes as well.
The GlideScope Ranger is a variant designed for use in pre-hospital airway management including air, land, and sea applications. This device weighs 1. The GlideScope Cobalt is a variant that has a reusable video camera with light-emitting core which has a disposable or single use external shell for prevention of cross infection. In August , the team at Verathon collaborated with Professor John Sakles from the University of Arizona Emergency Department in achieving the world's first tracheal intubation conducted with the assistance of telemedicine technology.
During this demonstration, Dr. Sakles and the University of Arizona Telemedicine service guided physicians in a rural hospital as they performed a tracheal intubation using the GlideScope. The superior performance of video laryngoscopes in airway management where cervical spine injury is possible has raised the question of whether these scopes should supersede direct laryngoscopy in routine airway management. Other "noninvasive" devices which can be employed to assist in tracheal intubation are the laryngeal mask airway        Some types of which may be used as a conduit for endotracheal tube placement , the lighted stylet,   and the AirTraq.
Cases of mild or severe injury caused by rough and inexperienced use of laryngoscopes have been reported. These include minor damage to the soft tissues within the throat which causes a sore throat after the operation to major injuries to the larynx and pharynx causing permanent scarring, ulceration and abscesses if left untreated.
The word laryngoscopy uses combining forms of laryngo- and -scopy. From Wikipedia, the free encyclopedia. Redirected from Laryngoscope. For the journal, see The Laryngoscope. View of the glottis as seen during laryngoscopy. See also: Tracheal intubation. This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. October Learn how and when to remove this template message. The history of the Royal Society of Medicine.
RSM Press. ISBN PMID Bel canto: a history of vocal pedagogy. University of Toronto Press, p. Proceedings of the Royal Society of London. JSTOR PMC Retrieved 28 August The Laryngoscope. Volume 15, pp. Australian Voice. Pioneer of direct laryngoscopy". New York: Edgar S. Retrieved 27 August Pediatric Anesthesia. J Voice. A manual of peroral endoscopy and laryngeal surgery. Philadelphia : W.
Saunders Company. Paediatric Anaesthesia. Miller Anesthesiology Research and Practice. Berry
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