I have emphasised enough about this last week with "horizontal ear to sternal notch" and "ramped up" position. If you are still don't get an optimal view despite doing these manoeuvres, one last thing which might help you before you move to your plan B is a "head lift" to visualize the cords. Here, with the tip of the laryngoscope blade sitting in the vallecula, you keep your right hand under the occiput and flex/extend the head. When you get an optimal view, fix the head at the same spot by supporting with an extra set of sheets.(see the image below)
The best thing to do with them is, inserting the scope like we insert the Oropharyngeal Airway (see image "a" below), and once you enter inside the oral cavity, turn 90 degrees anticlockwise that brings you in the required position.(image b)
a - Inserting the scope in OPA manner and turning
it in 90 degree anticlockwise direction
Asking your assistant to pull the cheek to the side
|Trying to insert the tube "straight - in" & blocking your own|
view of the cords (Wrong)
|Inserting the tube from the right side, not|
interfering with the view (Right)
- Keeping the scope inside the mouth even after passing the bougie in - until you rail road the tube over the bougie. DO NOT TAKE THE SCOPE OUT and try to jam the bougie inside!
- Learn how to differentiate between trachea and oesophagus with the bougie: Keep advancing the bougie inside gently and feel for the tracheal clicks --> If you hit the carina OR feel the tracheal clicks as you advance the bougie, then you are in the trachea. In contrast, if don't feel any clicks or resistance and are able to advance the bougie almost completely inside, then you are in the GI tract.
Special note of thanks to Dr. Azhar and the authorities of Simulation Lab, Apollo Health City, Hyderabad