Great insight into a methodical approach to vomitus in the airway as taught by Richard Levitan on EM Cases Best Case Ever 39. His approach emphasizes ergonomics, purposeful movements, and spacial visualization. I’ve broken his steps into 3 main objective to help me remember

  • Place blade and suction 
    1. Lower force and stress by grabbing scope with two fingers
    2. Scissor technique to open jaw
    3. Place blade and distract tongue and jaw with blade
    4. follow curvature of blade down
    5. suction any visible secretions
  • Manipulate blade to enter valecula
    1. find the uvula
    2. advance blade slightly
    3. find palatival arch
    4. advance blade to hypopharynx
    5. find the tip of the epiglottis
    6. suction further down to clear deeper view
    7. drop blade into valecula
  • Find chords and place tube
    1. change grip (more force, grips where handle meets blade)
    2. extend force down the blade’s path
    3. More suction, cricoid manipulation (if needed)
    4. Place tube when chords come into view

Levitan also shares his initial approach to unexpected hypoxemia

  1. Move patient up in bed and lift head of bed
  2. place high flow NC
  3. Jaw thrust to open airway
  4. Place non-rebreather

Once these initial 4 steps are done, continue with indicated airway management depending on response (BVM, CPAP, intubation, etc.)

Full podcast here:

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