TUBE DELIVERY: Has its own set of skills. To be successful you need to know 1. The anatomic structures that might impede your progress 2. Have an understanding of the spatial relationships of the tube as it travels your line of sight, approaches the glottis & enters the trachea. 
Safety tip: NEVER FORCE A TUBE, FINESSE it with the skills highlighted here or you will cause injury to these delicate structures. #protectedairway #protectyourpatient
MOUTH ENTRY: 1. enter from the right angle of the mouth 2. straight to cuff tube shape 3. rotate up from under your line of sight. This will keep you from blocking your view of the target.
GIF of Kevin High MD @VUMC_EM
GIF of Kevin High MD @VUMC_EM
BELOW LINE OF SIGHT: Here is @airwaycam demonstrating this technique.
STRAIGHT TO CUFF: Notice the Straight to cuff shape of the tube on the prior gifs. We cover why tube shaping is so important for tube delivery elsewhere.
TOO CLOSE!! 🔍Kovac's sign: That great view is a PROBLEM! 1. No room to tube tip to target. Will be too low & you will be unable to maneuver it into the glottic opening 2. Angle of approach is too steep - tube will impact the tracheal rings and get stuck.
PARTIAL VIEW IS BETTER. "Black hole sign" 1. With this view you have room to maneuver tube to target 2. Angle of approach will allow for better passage of tube past tracheal rings.
HANG-UP: when you're on target but the tube won't pass remember this.
Stuck at the larngeal inlet ?ROTATE LEFT
Stuck at the tracheal rings? ROTATE RIGHT
Here's @kovacsgj using a great model to explain why.
Here's @kovacsgj using a great model to explain why.
THUMBS UP ! 👍 Another great maneuver demonstrated by @kovacsgj for passing the tube that is stuck on the tracheal rings. This is particularly useful for HA/VL where the stylet angle is greater than 60 degrees.
You got this! Make sure to explore all 3 threads:
1. Epiglottoscopy 2. Laryngeal exposure 3. Tube Delivery. Practice your new skills here in the self-directed portion of #PAC then head to the coaching area where expert faculty can watch your technique & give you feedback.
1. Epiglottoscopy 2. Laryngeal exposure 3. Tube Delivery. Practice your new skills here in the self-directed portion of #PAC then head to the coaching area where expert faculty can watch your technique & give you feedback.
