CASE A 22-year-old man was brought to the ED complaining of abdominal pain after a rollover motor vehicle accident. He was the front seat passenger and was wearing a seat belt. Although he was trapped in the vehicle and it caught on fire, he did not suffer any cutaneous burns. History The patient's past medical history was significant for attention-deficit hyperactivity disorder. He admitted to using tobacco and alcohol socially, but denied illicit drug use. He denied any medication use or drug allergies. A review of systems was positive for complaints of abdominal pain and anxiety. Physical examination The patient's vital signs were: BP, 112/51 mm Hg; heart rate, 110 beats/minute; respirations, 23; SpO 2 , 95% on room air; and temperature, 37.4° C (99.3° F). On ED arrival, he was awake, alert, and oriented but appeared anxious and agitated. His pupils were equal, round, and reactive to light. His head was normocephalic with a 2-cm laceration on the left ear. The pati...
Purpose: To describe intubation success and the device manipulations needed to obtain adequate glottic views to facilitate successful first attempt tracheal tube passage with the Airtraq.Methods: Retrospective audit of anonymously collected prospective data from a departmental equipment purchasing committee sponsored device trial. Descriptive data is provided. The odds of successful passage of the tracheal tube on the first attempt without repositioning when the posterior arytenoids cleft was in the left lower quadrant of the view from the Airtraq was compared to its location in any of the other quadrants using a contingency table and presented as OR (95% CI).Results: All patients were successfully intubated with the Airtraq (median time 28 seconds). Device repositioning to attain adequate view of the glottis occurred in 30-48% of insertions depending on whether it was a back-up or rotational motion. The odds of successful intubation on first attempt was thirty times higher when the posterior interarytenoid cleft was in the lower left quadrant of the operators view (95% CI [4-300], p<.0001.Conclusions: Our results support the ease of use and attainment of skills of the Airtraq in inexperienced users. More importantly, our results suggest that maneuvering the device to obtain a view of the glottic structures in the lower left quadrant of operator’s view leads to the highest likelihood of first attempt intubations success.
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