Paediatric airway gems

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 thoughts on “Paediatric airway gems”

  1. 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.

    regards
    and keep up the good work.

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

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