Paediatric airway gems

January 28, 2011 by  
Filed under All Updates, EMS, ICU, Kids, Resus

Dr Rich Levitan has made an enormous contribution to the science and practice of emergency airway management, as his bibliography demonstrates. In a new article in Emergency Physicians Monthly entitled ‘Demystifying Pediatric Laryngoscopy’, Rich covers some great tips for optimising laryngoscopic view in kids.

Check this excerpt out for an example:

During laryngoscopy in infants the epiglottis and uvula are often touching; the epiglottis may be located within an inch of the mouth. Often the epiglottis lies against the posterior pharynx, and it is critical to have a Yankauer to dab the posterior pharynx as the laryngoscope is advanced. Hyperextension of the head pushes the base of tongue and epiglottis backwards against the posterior pharyngeal wall, and makes epiglottis identification more difficult

Gems like this come thick and fast when you hear or read what Rich has to say. Seven years ago I was left reeling after finishing his ‘Airway Cam Guide to Intubation and Practical Emergency Airway Management‘ which profoundly influenced the way I practice and teach emergency airway skills, including on the Critical Care for Emergency Physicians course.

I’ve finally gotten round to booking a place on one of his courses in March in Baltimore. I’ll let you know how it goes. In the mean time, I’d like to point you toward his training videos as a great educational resource, like this one that demonstrates for novice laryngoscopists the difference between the appearances of trachea and oesophagus, the former having recognisable, defined posterior cartilagenous structures:

Demystifying Pediatric Laryngoscopy
Emergency Physicians Monthly January 19, 2011


3 Responses to “Paediatric airway gems”

  1. Minh Le Cong on January 30th, 2011 06:01

    Hi Cliff
    Firstly thanks for this website on resuscitation and critical care. Its fantastic
    Secondly I agree wholeheartedly with your opinion of Richard Levitan. I have met and had him run two airway workshops for us at RFDS Cairns base and he is THE MAN for emergency airway knowledge, skills and teaching. I had a similar epiphany after reading his Airway manual and recommend it to anyone serious on improving their airway skills.

    Thirdly I would recommend his article entitled “No Desat” in Emergency Physicians Monthly December 2010 edition, where he talks about apnoeic oyxgenation and use of nasal cannulae during laryngoscopy. This is a total game changer technique and works so brilliantly it makes you wonder why no one ever teaches this stuff in basic airway training.

    and keep up the good work.

    Minh Le Cong
    Medical Officer, Royal Flying Doctor Service, Cairns , Queensland, Australia

  2. Cliff on January 30th, 2011 06:27

    Thanks Minh. The link to that great article you refer to is
    Will try that on my next bariatric retrieval patient


  3. The LITFL Review 004 - Life in the FastLane Medical Blog on January 31st, 2011 02:17

    [...] As well as highlighting the work of Rich Levitan, who we featured in last week’s review, in Paediatric airway gems, he finds out that helicopters probably do save lives in Helicopters and trauma: systematic review [...]