Cliff I am sure you have also noticed that people tend
to stand on the right to do cricoid pressure. This has a
natural tendancy (IMHO) to push the larynx to the left
which is exactly the wrong way to go (remembering the
BURP technique to aid larynogoscopy - back, up to the
right with pressure). My only ever grade 4 view was
corrected by relaxing the cricoid - I am still convinced
that the skin was opposing the oesophagus (the larynx
being pushed way over to the left.
Simon
>>Should we start a list here for everybody else's
favourites?
>
>Most of my difficult views have been corrected by
asking the cricoid presser
>to ease up a bit, or even let go. I've supervised many
RSIs where the
>frustrated junior laryngoscopist has changed blades,
head position etc. and
>can't see anything other than the epiglottis or even
nothing at all. When
>I've taken over I've had the same view and the only
thing left to change is
>the Sellick's manoeuvre, which when adjusted has
resulted in a
>gasp-of-relief-inducing grade I view. The worry is that
this is often with
>folks who say they know how to do it (ICU nurses,
paramedics, ALS providers)
>but on re-evaluating their technique (after the horse
has bolted) they often
>don't. My most 'anal' check pre-intubation now is the
intended cricoid
>pressure technique.
>
>
>Cliff Reid
>Emergency Physician, London
>____________________________________________________
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>
>
Simon Carley
SpR in Emergency Medicine
http://www.bestbets.org
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