critical care medicine
How To Do Orotracheal Intubation Using Video Laryngoscopy
Positioning for Orotracheal Intubation Using Video Laryngoscopy
The sniffing position is the optimal position for endotracheal tube insertion; however, if the neck cannot be positioned this way, the laryngoscope camera often provides adequate visualization. The sniffing position is used only in the absence of a cervical spine injury: Position the patient supine on the stretcher. Place folded towels or other materials under the head, neck, and shoulders, flexing the neck so as to elevate the head until the external auditory meatus lies in the same horizontal plane as the sternal notch. Then tilt the head so that the face aligns on a parallel horizontal plane; this second plane will be above the first. In patients with obesity, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck (see figure Head and neck positioning to open the airway ). A: The head is flat on the stretcher; the airway is constricted. B: Establishing the sniffing position, the ear and sternal notch are aligned, with the face parallel to the ceiling, opening the airway. Adapted from Levitan RM, Kinkle WC: The Airway Cam Pocket Guide to Intubation, ed. 2. Wayne (PA), Airway Cam Technologies, 2007. If cervical spine injury is a possibility: Position the patient supine or at a slight incline on the stretcher. Maintain in-line stabilization to avoid moving the neck and use only the How To Do Head Tilt–Chin Lift and Jaw-Thrust Maneuvers or 