Dentures can be sneaky during emergency intubations – in this patient the dentures became loose with laryngoscopy. If they can be removed as you open the mouth for laryngoscopy it’s always an advantage to have them out to make laryngoscopy easier.  

This video starts with bougie between the cords, in the trachea. We have been practising ‘keep the view for CO2’ for a while now to check for good ETT placement and depth throughout cuff inflation, bougie removal and initial breaths. This is an example of what watching during cuff inflation adds. The balloon ends up on ‘our side’ of the cords and is pushed in further until the cuff sits just below cords. 

Maintaining a view of the cords during cuff inflation, bougie removal and initital breaths increases our chances of noticing an ETT that is slowly sneaking its way to being too short. The black lines on this ETT begin at the cords but note that at the end they are both ‘our side’ of the cords, risking the tube being too short. This tube quickly becomes an unintentional extubation and reintubation. 

This video follows 122; in the same patient, the iGel was removed and the patient was successfully intubated using the CMAC. On review, it was thought that the larynx looks a little red after being squashed.

This patient had been found unresponsive with a low GCS; during initial hospital transport, their GCS dropped further leading to a respiratory arrest. They were bagged with BVM and transported to a small local hospital, where a size 3 iGel (SGA) was inserted. On arrival of our team, the iGel seemed positional; the etCO2 trace was lost at times and there were significant secretions with low SpO2. Considering that initial attempts at intubation had been unsuccessful, the team attempted flexible Ambu AScope assessment through the iGel. They noted a ‘squashed’ appearance of the laryngeal inlet, attributable possibly to the small iGel pushing past the larynx “too deep”. We have no CMAC views of the iGel site but successful CMAC intubation followed - this video is numbered [123]. Our intubation via LMA card is here: sydneyhems.com/resources/emergency-action-card/intubation-via-lma/ ;