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Advanced Emergency Nursing Blog from AENJ
The concepts, concerns, clinical practices, researches, and future of Advanced Emergency Nursing.
Friday, October 02, 2015

All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances,
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurse’s arms;
And then the whining schoolboy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honor, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into the lean and slippered pantaloon,
With spectacles on nose and pouch on side;
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.

William Shakespeare’s
As You Like It Act II, Scene vii.


Recently, a nurse [Leonard] wrote of her father’s illness and learning to cope with changing roles and attaining empowerment as a nurse-advocate in her father’s care. It has been reposted widely.


Her story speaks to many of us as we ourselves age and retire; face the aging and end of life problems of our parents; reevaluate our roles as “good child” and and a “good subordinate” healthcare worker; and be able to speak up as needed. Her story has the advantage of having time to evolve and is still ongoing.


A large number of “older” nurses are now retiring, or withdrawing in hours of work, or from bedside care. I call this part of a “Broken-Down Baby Boomer Syndrome.” We are old, and if our parents still live, they are very old. The formerly up-and-coming younger professionals are hitting midlife stride but are developing their own aches and pains as their parents, no longer young, retire or become older and sicker. The youngest professionals are working, playing, starting families, and struggling with a completely different economy. Those second jobs will take a toll on their physique and psyche. More nurses yet will need to be recruited and educated to replace those leaving and to serve a population that will be 25% geriatric.


It is very off-putting to have one’s soundly reasoned professional advice to a parent be ignored, dismissed, or thought to be insulting the parent’s competence. One is the whippersnapper child, presumptuous, and even “planning to put me in an old-folks home.” Other divisive influences might exploit such contretemps to gain a foothold of control and misuse the trust that is given.


When the parent gives excuses, rationalizations, or even confabulates explanations, one really wants to believe those, and hardly think to question and investigate whether such is so. “Trust, but verify.”


With the parent’s provider, one might be thought to be only the “driver” for the appointment and not a natural ally with a common patient. (What, challenge my judgement?) When there are multiple specialist providers that can be too many blind men examining the fabled elephant and having different findings; polypharmacy is often a result. The unifying thoughts of the gate-keeping primary provider may be ignored by the elder who may respect the specialist more.


When there are different perceptions as to medical needs, one must try to depersonalize the family relationship briefly to ask oneself “If this were my patient, what would be the right thing to do?” As you owe a patient the kindness that you would show a parent, so must you also owe your parent the same professional advice that you would give your patient. Explaining and exploring the proposed action as the most reasonable step to return to status ante quo may be the most helpful approach.


Some degree of cooperation and shared understanding by the parent is required, as Powers of Attorney for Health Care Decisions are valid only during the incapacity of the parent and there is often a long and debatable period as to how much relative capacity actually exists in legal terms. A General Power of Attorney would be needed to manage finances and property. —Mom or Dad may seem to close relatives to be neglectful of responsibilities or “not doing well” yet still may have sufficient faculties to pass an interview to determine capacity (in the legal sense) and be bluffing their way along. Subtle signs may be noticed only by family but the law requires “hard” signs of grave disability to understand or manage affairs and plan for meeting basic needs.


If one can achieve some agreements beforehand to any serious illnesses, some problems can be forestalled. Be aware of friends and confidants who might be a willing ally. On touchy matters, such as a mental status evaluation, circumspection in supporting the recommendations of care agencies may be needed lest one be thought too ardent in changing status.


I learned from my mother that one must plan ahead for infirmities and old age just as much as planning for the events of today. There are no easy answers or predictable solutions for all possibilities, but trust and planning help.


Leonard, Julie, BSN, RN. “From our readers: When your parent is the patient.” American Nurse Today website. American Nurses Association (ANA), August 2015 Vol. 10 No. 8.




Tom Trimble, RN CEN


All opinions are solely those of the author.

Readers must verify validity to their own practice.




Monday, September 14, 2015



Preface: In January 2015, this blog provided resources for Emergencies of the Third Trimester, however, we did not separately discuss airway management in third trimester pregnancy.


What:   When a third-trimester pregnant woman is stopped in your ED, one cannot help having concern for things that might go wrong. She’s there because your hospital is under-resourced, has injury or illness not thought related to gravidity, is too “sick” to make it to OB Labor/Delivery, or you’re trying to get OR to open. In rural Critical Access Hospitals, or austere conditions, you may be all that is available.

While one first thinks of problems with the pregnancy or the fetus, the woman may be there for reasons that may impact her life or that of her child: e.g., a motor vehicle collision may inflict injuries; especially as the seat belt may not have been worn due to poor fit (riding above the pelvis) or discomfort over the gravid uterus, thus she may have been at greater risk than other passengers. The greatest risk to the child is the risk to the mother.


Why:  Why did Rapid Sequence Induction by anaesthetists develop? Because of the grave concerns of airway management, difficult airway, and aspiration common to third-trimester pregnancy. 

Present obstetric anesthesia practice fosters awake delivery ± regional anesthesia whenever possible to avoid intubation; but when intubation is clearly needed, it is best performed with aspiration precautions, RSI, and a cuffed tube.

When difficulty occurs, second generation supraglottic airways may be used for rescue, especially one that favors conduit intubation through the SGA; concurrent ventilation with a bronchoscopy swivel adapter during fiberoptic guidance is ideal.


When: The patient needs airway control for resuscitation of mother or child, emergent surgery for maternal or fetal indications; block cannot be effected or would be unsafe. The concept of post-mortem caesarian delivery is being supplanted by ante-mortem resuscitative uterine extraction to save both mother and child.


What’s different about late-gravidity airways? – What to do about it?

  1. Increasing maternal weight, even morbid obesity, impairs stomach-emptying, and a diaphragm raised by baby’s presence, thus each partuitent is essentially a “full-stomach” patient. Further, there may also have been recurring esophageal reflux irritating the vocal cords.

  2. These reasons also decrease functional reserve capacity (FVC) of the lungs, and inhibit diaphragmatic excursion, especially if supine: patients can desaturate very quickly. Use the NODESAT technique. Monitor oximetry and capnography.

  3. The weight of the fetus upon the aorta and IVC, especially when supine, embarrasses return circulation, contributes to shock, and O2 delivery to the fetus may be sluggish. If the patient cannot be managed with a leftward tilt of the body and bolstered there, then Manual Displacement of the Gravid Uterus (leftward) is mandatory.

  4. Due to weight gain and fluid retention, tissues of the upper airway may be edematous, engorged, and friable, impairing laryngoscopy and intubation, also making manual upper airway manipulations and BVM ventilation more difficult. Obesity/Morbid Obesity increases the risks. Be prepared with a bougie or ventilating introducer such as the Frova Catheter, and with smaller-than-expected endotracheal tubes.

  5. As above, especially in short-necked women and obesity, the chest contours may be raised, and breasts enlarged, to the extent that your customary laryngoscope handle may not fit between the airway and the chest wall.

    –“Ramp” the patient to a 30° angle with the “ear hole” level with the manubrium/sternum, and face parallel to the ceiling. This helps all of the above, improves visualization of the glottis, improves FRC, improves oxygenation/ventilation, and minimizes regurgitation/aspiration.

    –Use a short or stubby handle, if available. If not, then de-mount the blade; insert in mouth sideways; rotate to correct A-P orientation; remount handle.

    –If you have difficulty visualizing your approach to the glottis while in the ramped position, consider:

    A) Using a footstool or standing on the end of the gurney to attain a superior altitude.

    B) Having an assistant who is facing “do the heavy lifting” taking over the laryngoscope handle while you look and direct.

    C) Lowering the bed, but not the head of the bed, and facing the patient yourself (or kneeling/straddling alongside on the bed surface), use your right hand to hold the inverted laryngoscope (like an Ice-Axe or Tomahawk) to perform laryngoscopy and manipulate the tube with your left hand.

    –A videolaryngoscope may be of great assistance.

    –If you foresee great difficulty, be fully set-up with a second-generation supraglottic airway (ideally, able to be a conduit for an endotracheal tube) and cricothyrotomy kit ready to go.

    –Don’t remain fixated on intubation. Oxygenation is primary. Ventilation is next. Neither requires an endotracheal tube. Call for help before, or upon first difficulty, not afterwards. More damage to the airway occurs with each attempt. Successful simplicity trumps a precarious triumph over adversity that results in a damaged airway or mother or child.



Kodali, B. S., Chandrasekhar, S., Bulich, L. N., Topulos, G. P., & Datta, S. (2008). Airway Changes during Labor and Delivery. Anesthesiology, 108(3), 357-362. [Free]


Isono, S. (2008). Mallampati classification, an estimate of upper airway anatomical balance, can change rapidly during labor. Anesthesiology, 108(3), 347. [Free]


Mrinalini Balki, M.B.B.S., M.D., Mary Ellen Cooke, M.D., F.R.C.P.C., Susan Dunington, M.A., R.R.T., F.C.S.R.T., Aliya Salman, M.D., F.R.C.P.C., Eric Goldszmidt, M.D., F.R.C.P.C.; Unanticipated Difficult Airway in Obstetric Patients: Development of a New Algorithm for Formative Assessment in High-fidelity Simulation. Anesthesiology 2012;117(4):883-897.

Figure 1. Algorithm for unanticipated difficult airway in obstetric patients. Ibid.


Munnur, U., de Boisblanc, B., & Suresh, M. S. (2005). Airway problems in pregnancy. Critical care medicine, 33(10), S259-S268


Geoff Jara-Almonte, MD and Hilary Fairbrother, MD  // Editor: Alex Koyfman, MD Resuscitation of the Pregnant Trauma Patient – Pearls and Pitfalls 2/6/2015


Cabrera, Daniel, M.D. A new mindset: from perimortem cesarean to resuscitative hysterotomy. EMBlog Mayo Clinic. Tue, Aug 25, 2015.


Weingart, Scott, MD. Use of the bougie for intubation.  YouTube. 6/2010.

Llobell, Francisca, MD PhD. Frova intubating catheter+ Jet rescue in mannequin. YouTube. May 24, 2014. 

Weingart, S. D., & Levitan, R. M. (2012). Preoxygenation and prevention of desaturation during emergency airway management. Annals of emergency medicine, 59(3), 165-175. [PDF]

Tom Trimble, RN CEN
All opinions are solely those of the author.
Readers must verify validity to their own practice.




Wednesday, August 19, 2015



It is a curious thing that people often think that we must have a special interest in medical shows on television or in movies, and should prefer to watch them, or that we will give expert commentary upon the depictions.


There is a difference, too, between actors as medical people, and medical people as actors. Yes, medical people sometimes play themselves, suckered in by the excitement of Hollywood, but are subject to the director's coaching which can compromise reality for the sake of visual and dramatic appearance or timing.


My absolute pet peeve, with ~95% prevalence, is backwards insertion of a stethoscope into the ears. It is usually the first clue of an actor rather than a medical person. I am countered with "Well, maybe some people wear them that way!" "No. They don't work that way."


Time is compressed, sped up, and some actions omitted or implied to maintain dramatic pacing. The classic example is the admission by actors of ER in TV Guide that a shot would begin with their gloves already on, snapping the cuff while coming through the door to imply being just put on. {You don't open a door with sterile gloves, do you?} It was also confessed that the clipboard was a reminder as to the pronunciation of medical words. A correct BVM bagging rate is never seen, as the 60 bpm rate is necessary for the visual pacing.


Other implied actions include oxygen administration (a staple of soap operas, where a cannula is in place regardless of putative pathology) usually to merely suggest severe illness: it is especially incongruous for a non-rebreather mask to be worn without oxygen flow [flat bag, no exhalation to mist the mask and be cleared by gas flow] {Now, that's just going too cheap in production values.}.


Twice in my career, I've spoken to patients soothingly during CPR so proficiently performed that spontaneous movements and sentient responses could be discerned and apparently calmed; ─a quite remarkable thing. I have never found it necessary to stop CPR to beat my patient and curse them, yelling for them to come back! Regardless, the successful resuscitation rate is admirable (and as yet, impossible) although the technique is terrible. Survival is so assured that

Tom Cruise and Daniel Craig can plan on electrically cheating death.


Nor, did I ever load a corpse into the ambulance and drive away with red lights and siren on. For me, patients have not woken clear-headed from non-survivable blunt trauma. And I am amazed at the number of heroes with a knock-out punch or baseball bat,  that avoid epidural bleeds, closed brain injury, or spinal trauma.


No doubt, you may have seen the "Ambu-slap" when the patient is loaded and a cop helps with a goodbye double-slap to the door to let the crew know that they can leave now. I've never been part of an ambulance crew that closes the loading doors on the patient and both of the crew get in front seats leaving the patient alone! Sometimes, as in Mother, Jugs and Speed, someone attends the patient without meaningful treatment, and the patient dies. Often, a cop rides in the back to get a confession, or a significant other is there for the patient's last words. Seat belts are omitted and frequently any treatment. Combining these activities/inactivity saves a good deal of screen time.


Soap opera hospitals' ICUs seem to always be a "nice" room with an unused ventilator or IV pumps in the room; with a small monitor nearby with NSR at an unvarying rate regardless of emotions. In fact, Dr. House's hospital seems to have no nurses at all unless he needs to be told a message. He also seems to be able to perform any imaging, intervention, or procedure regardless of which specialty actually owns it. Angry patients who pull out their own IV never bleed from the hole just unplugged.


Stated dosages are often vague, e.g., the scientific sounding "Give him 3 c.c.'s." Drug names may be obscured for safety's sake (Let's hope.).


Injections are given with the needle "to the hilt." Never more so than in the infamous over-the-head resuscitative intra-cardiac injection in Pulp Fiction. The Rock also features intra-cardiac injection. Generally, drugs are shown to have immediate effect (dramatic pacing) regardless of drug or route (IM). When I was young, abductees in black and white movies would be overcome with "rag & bottle" Chloroform (and no attention to the airway), now, it's often a stab injection to the neck (gives me the willies), and especially in the case of Dexter using unbelievable amounts of Etorphine/M99.


This attention to detail can have interesting consequences. I was completely silent while walking out of (in my opinion) the insane and execrable Flatliners. My wife commented to me, "You know, I didn't see the name of a Medical Advisor in the credits." I could only grit my teeth and say "That's probably because no one was willing to put their name on it!" As the tagline of the movie said, "Some lines shouldn't be crossed."


Tom Trimble, RN CEN
All opinions are solely those of the author.
Readers must verify validity to their own practice



Wednesday, July 29, 2015

Norman E. McSwain, MD FACS

Norman E. McSwain, Jr., MD FACS, Trauma Surgeon, Pioneering EMS Educator ,and Advocate for PreHospital Care Systems; dies at 78 years of age on July 28, 2015, in New Orleans, Louisiana, following an intracerebral hemorrhage on July 20th, 2015.



The Journal of Advanced Emergency Nursing mourns his death, but honors and celebrates the legacy of his lifetime of devotion to victims of trauma. We commend his life of service and teaching as an inspiration to be remembered and continued by others.


Dr. Norman McSwain

Additional information about Dr McSwain's life and work can be found at:





James Jude, MD


James Jude, MD, early Pioneer in Cardiac Resuscitation, developer of External Chest Compressions, and "father of modern cardiopulmonary resuscitation" dies at age 87, on July 28, 2015, "of complications from a rare Parkinson’s disease-related ailment.

Dr James Jude demonstrating chest compressions

Journal of Advanced Emergency Nursing mourns the death of Dr James Jude, but celebrations the life and his accomplishments. His work has restored the life of many who had "hearts too good to die," given hope to others at times of crisis, and helped teach us to persevere when caring for the apparently dead.



Additional information about Dr Jude's life and work can be found at:



Friday, July 10, 2015


You are fortunate to have a “q***t” shift with some slack time that could be put to good use and some fun.


How versatile are your airway skills? Oh, sure, you can handle any supine situations! Gather everyone. Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes!


Most airway management is done with the patient supine and on a table. Most training is likewise done with the patient on a table. Patients in their moment of crisis may not be in such a position! They may be entrapped; have limited access; may be midway in an operating position that can’t be changed; may need to be sitting due to pulmonary edema, morbid obesity, aspiration prevention or for awake intubation.


Try these situations.

  • A “chunky” kid has been sedated for a complicated wound repair, but soft-tissue upper airway obstruction (needs tonsillectomy, too) ensues. Snot drops down from the back of his nose irritating the glottis, and the stridor of partial laryngospasm is heard.

    Yell for help! Do an excellent Triple Airway Maneuver. Add gentle rotation of the neck seeking better airway opening. Add Larson’s Maneuver of painful pressure at the “laryngospasm notch” to break the spasm. Add CPAP with an anesthesia bag, or a BVM with PEEP valve.

    If all improves, turn patient on side to increase diameter of airway, continue respiratory support, and allow to waken. If laryngospasm continues, use succinylcholine by any route: IV; Intralingual; IO; IM. Continue support; intubate.

  • Your patient is on his side and, inopportunely, is either too difficult or not ready to be turned. Practice Bag-Valve-Mask ventilation in the lateral position. Insert OPAs, NPAs, supraglottic airway, deliver an ET tube through the SGA. Practice DL/VL and intubation laterally.

  • The patient is prone (after c-spine clearance) to repair his occipital laceration. He is not easily turned with the help available. Practice BVM assist, and insertion of airways (OPA, NPA, SGA, ETT via SGA, DL/VL & ETT, digital. You will be working from underneath.

  • Good on you, if you already “ramp” morbidly obese patients with the ear-canal-to-level-of-sternal-notch. Now imagine a very large and heavy head, very “jowl-ly” facies, and “no-neck.”  Try a very-ramped or sitting position. Lower the entire bed, or stand on a stool to gain a vantage point above the patient’s mouth, facing him,  insert your laryngoscope or videolaryngoscope upside-down with your right hand. Pull down and forward to visualize the glottis. Deliver the tube with your left hand.

    This is called by several names: Inverse intubation; Ice-Axe or Icepick intubation; Tomahawk Intubation, Face to Face Intubation, or Aussie Intubation. You are using gravity and better mechanics to manipulate the scope and jaw rather than fatiguing yourself. Variation: Assume an entrapped sitting patient. Try intubating digitally, +|- bougie. Try inserting a supraglottic airway; then deliver an endotracheal tube through your SGA.

    A form of awake (or ketamine-dissociated) intubation can be done in this way with adequate topicalization of local anesthetic.

  • Intubate your patient on the floor where he lies. Try different positions to see what works best for you. Inverse intubation while straddling the patient or alongside. Prone on your elbows behind the patient’s vertex. Right and left lateral positions (you lying on your side, behind the head). Sitting behind the head (if cervical injury excluded, the head might be supported on your calf.) Try positions with a rescue collar on the manikin or Manual In-Line Stabilization being held.

    Do this with a patient who has slumped and fallen supine with his head in the corner of the bathroom (airway support and BVM assist; place collar, place scoop or spine board and "extricate" patient to an exam room.

  • Importantly, you should practice airway support and BVM facing the patient "from the south" (facing cephalad). You may be assisting an airway manager (who's in the vertex position) who needs extra jaw thrust or lift. The proceduralist may be repairing a head laceration on a child who becomes too sleepy and needs some mask support. A problem may occur in the CT or MRI scanner. There may be a cluster of people at the patient's head, in a room too small, and you are the one who can see the see-saw of thoracoabdominal dysynchrony of breathing and tracheal tug of a now-obstructed airway. Reach up to the patient with the mask and apply inverted control. When all is OK, complete the procedure with the support of the mask and /or any needed airway devices.

    For infants and small children, I stand facing the patient from either side towards the head. My hand reaches under the jaw, lifting it and tilting the head with my thumb and ring (4th) fingers, while my index/pointer (2nd) and middle (3rd) fingers hold the mask in place (correctly fitted, with the mouth open). A pad should be under the thorax to maintain the neutrality of the neck and provide space for the large occiput.

    Someone is intubating the supine patient from the vertex (perhaps, even on a table, as usual) and perhaps petite or fatiguing is struggling to get sufficient visualization by direct laryngoscopy. Practice providing assistance with a two-handed jaw thrust, or “skyhook” a jaw lift by raising it with thumb and first finger as the hook. Larson’s maneuver (painfully distracting the condyles of the mandible) can be provided if there is laryngospasm.

Useful Take-Away Tipsu:


ü      A lateral position favors widening of the upper airway in obesity, and obstructive sleep apnea; and may assist in drainage of regurgitation or vomitus.

ü      Rotating the neck, with positive pressure ventilation may help break a partial laryngospasm. If cannot be ventilated (ball-valve obstruction of the glottis by the positive pressure; then NMB paralysis MUST be done.

ü      A semi-sitting, sitting, or Reverse Trendelenburg's Position, takes weight of abdominal viscera off the diaphragm; improves Functional Reserve Capacity; minimizes risk of aspiration; dependency of upper airway soft tissue improves available airway space; improves visualization of the glottis; and lessens the work of laryngoscopy.

ü      A prone position does not guarantee a safe patent airway. It limits respiratory excursion by the weight of the body, and by any viscera pressing against the diaphragm. Bolsters can provide room for the chest and abdomen to be free. SGAs and some methods of intubation can be placed in the prone position.

ü      Due to a large occiput, infants and small children need pads under the shoulders and torso to prevent flexion of the head/chin upon the neck and airway obstruction thereby.

ü      Patients being rescued from awkward positions need airway control where they lie, rather than delaying until post-extrication.

ü      With foresight, plan for your alternatives based upon what you have now, until the patient can be brought safely to conventional resuscitation room settings. Be wary of any patient with limited access, and watchful for any airway or respiratory compromise.


Your self-assigned goal is be prepared by forethought and practice to deal with any awkward circumstance. Your team is prepared, and camaraderie is shared. Flexibility of mind and skill bodes well.




Wiget, Urs & Torres, Eric. {Before} 19 May 01. Trucs et ficelles du métier:

Intubation extra-hospitalière : Intubation inverse, technique dite de «l’intubation au piolet {Defunct} Archived at <>.  Google Translation.


Smally, A. J., Dufel, S., Beckham, J., & Cortes, V. (2002). Inverse intubation: potential for complications. Journal of Trauma and Acute Care Surgery, 52(5), 1005-1007.


Weinberg, G. L. (2000). A versatile alternative to standard laryngoscopy. Anesthesiology, 93(1), 309.


Gürtner, I., Kanz, K. G., Lackner, C., & Schweiberer, L. (1993). Inverse intubation beim polytrauma: indikation, technik, erfahrungen. Intensivmedizin und Notfallmedizin, 30, 426-7.


Tesler, J., Rucker, J., Sommer, D., Vesely, A., McClusky, S., Koetter, K. P., ... & Petroianu, G. A. (2003). Rescuer position for tracheal intubation on the ground. Resuscitation, 56(1), 83-89.


Michael F. Murphy, MD, Fred Ellinger Jr., NREMT (2008) . A Tight Squeeze Airway management for the limited-access patient. December 2008 JEMS Vol. 33 No. 12


Larson, P. C. (1998). Laryngospasm-the best treatment. The Journal of the American Society of Anesthesiologists, 89(5), 1293-1294.


Nickson, Chris. Laryngospasm - Life in the Fast Lane Medical Blog. 2015.


“zmorgan morgan” Laryngospasm. [Video] Oct 30, 2012.

[43” nice video of breathing effort against obstruction of laryngospasm; lists consequences.]


Amato, Anthony. Pediatric Laryngospasm. [Video] Sep 15, 2014.


Larson Maneuver. NEJM Video. Mar 27, 2014.


Huitink, Johannes, MD PhD.  The one second intubation technique. [Video] Feb 11, 2014.

[Face to Face SGA Conduit ET Intubation, with video ETT]


High, Kevin. Digital Intubation. Vanderbilt University Emergency Medicine.

Estis, Gad. Digital Intubation. [Video]

[Note the angled ETT to rotate tube into glottis without obstructing visual path.]


Alenazty, Faisal. Face to Face Orotracheal Intubation. [Video] Sep 15, 2013.


Alternate Jaw Thrust. [Video]
[One version of inverted jaw thrust facing cephalad]


Podder, S., Dutta, A., Yaddanapudi, S., & Chari, P. (2001). Challenges in paediatric mask holding; the ‘claw hand’technique. Anaesthesia, 56(7), 697-699.

Lee, Daniel E., MD PhD - UCSDTraumaBurn. Pediatric Airway Management. {Pediatric Airway: brief intro for trauma providers} [Video] May 21, 2012.
[Time=33’11” Presentation]

EMS World. Paragon Medical Education group. Advanced Airway Management Techniques. [Video] Nov 19, 2013.
[Time=21’29” Laryngoscopy & Intubation didactic in Cadaver Lab, covering technique, problems, tips, direct or video laryngoscopy with bougie, etc.]

“Dr Gallagher’s Neighborhood” Lesson 3 - Mask Ventilation: MICU Fellows Airway Course. [Video] Dec 19, 2012.
[Review of sound BVM use, torso tilt, neck rotation, adjuncts, ergonomics.]


Chrimes, Nicholas. Face Mask Ventilation by Chrimes at SMACC Gold. [Video] Jan 28, 2015.
[Dr Chrimes demonstrates & compares BVM vs. Anesthesia Bag; two-hand vs. two-thumbs mask hold; leak & obstruction; OPA & NPA]

The Case for Teaching Face-to-Face (Tomahawk, Ice-Pick or Inverse) Intubation. [Poster Presentation by and based upon the article:
Venezia, D., Wackett, A., Remedios, A., & Tarsia, V. (2012).
Comparison of sitting face-to-face intubation (two-person technique) with standard oral-tracheal intubation in novices: a mannequin study. The Journal of emergency medicine, 43(6), 1188-1195.

Pap, R. (2013). A comparison of airway devices for the simulated entrapped patient (Doctoral dissertation).




Tom Trimble, RN CEN
All opinions are solely those of the author.
Readers must verify validity to their own practice.

About the Author

Tom Trimble
Tom Trimble, RN CEN is the Online Editor of AENJ.