Yen Chow

Thunder Bay ED + Ornge MD, luv Airway CRM MedEd Tech 3D OpinionsOwn TweetsNotMedicalAdvice RetweetsNotEndorsing airwayNaUT

[Yen Chow @TBayEDguy]

I keep trying to remember (but paranoid I might forget) to talk directly to patient (same as when they might be awake), when they present with what seems to be GCS 3 especially when I am stressed/distracted by them being critically ill or injured

[Yen Chow @TBayEDguy]

Airway Workshop 2026 with EM residents

[Yen Chow @TBayEDguy]

Airway teaching stuff

[Yen Chow @TBayEDguy]

Universal VL

[Yen Chow @TBayEDguy]

attribution https://t.co/aAA9C1TJk6 image BT363K

[Yen Chow @TBayEDguy]

cervical spine precautions in airway management https://t.co/SMToZ2do2R

[Yen Chow @TBayEDguy]

Lighten up Vader!

Keep your laryngoscope hold fingertip light, low with inward elbow
https://t.co/j4oKkmx5SR

[Yen Chow @TBayEDguy]

https://t.co/tejD7C0sR4

[Yen Chow @TBayEDguy]

Start with light fingertip laryngoscopy, holding VL or DL SG or HA blade with a choked up grip and just deploy whatever blade length is needed. More precision to blade tip movement with your fingertips holding base of blade versus being high up on handle.

[Yen Chow @TBayEDguy]

https://t.co/nXlB2UXYTX

[Yen Chow @TBayEDguy]

Start with light fingertip laryngoscopy, holding VL or DL SG or HA blade with a choked up grip and just deploy whatever blade length is needed. More precision to blade tip movement with your fingertips holding base of blade versus being high up on handle.

[Yen Chow @TBayEDguy]

Too much force locks tissue in place and does not allow sweeping and clearing for view or tube delivery space. Force applied in the wrong direction and spot will not improve things no matter how much strength is used and only serves to traumatize airway and panic operator.

[Yen Chow @TBayEDguy]

Less force and strength is required so the intubator's hand does not fatigue. Also only moving a few pounds of tongue and soft tissue. Light exploratory force allows one to find sweet spot, see how tissue responds. Is a technique of millimeters and degrees of gentle exploration.

[Yen Chow @TBayEDguy]

@doctimcook @dasairway Most manikins teach the wrong techniques unfortunately. Too much force required.

[Yen Chow @TBayEDguy]

@doctimcook @dasairway And even with VL they can intubate the esophagus. Again it is all about proper technique and practice. Unfortunately it is a very low opportunity high acuity technique. Ability for occasional intubators to see actual VL videos of intubation + coaching about it is invaluable IMHO

[Tim Cook @doctimcook]

@TBayEDguy @dasairway Occasional intubators also sadly intubate the oesophagus too often
- I recently reviewed a paper describing occasional intubators in a high resource setting, with a >10% oesophageal intubation rate (many unrecognised).

[Yen Chow @TBayEDguy]

@doctimcook @dasairway I agree. VL best especially standard geometry Mac. VL not hard but needs right technique and knowledge of its pitfalls. I am a big proponent of VL for every single intubation and so happy it is finally seeing more universal use in ED since COVID.

[Tim Cook @doctimcook]

I’ll gently push back

VL is an intrinsically better technique
It improves laryngeal view, first pass success, reduces failure, force, trauma and complications (26,000 patients in Cochrane r/v with another 20,000 waiting to be added)

In Prekker’s DEVICE study this nice supplementary graph showed how VL benefited every intubator except those with lots of experience with DL but little or no VL experience (who one might characterise as “laggards” in terms of adoption)

https://t.co/KKTVJ87s7Y

That said - clinicians should not be undertaking high risk procedures (intubation fails dangerously) without appropriate training…..which brings us back to “the educationally difficult intubation”*

Yes I’m resisting talking about tools with tools 😊

[Yen Chow @TBayEDguy]

@doctimcook @dasairway Agree

but I worry/think people esp occasional intubators run into difficulty often.

IMHO it needs deliberate practice, precision and calmness.

Being stuck in the same loop of difficulty and loss of time perspective can be so easy to fall prey to.

[Tim Cook @doctimcook]

Anaesthetise
Paralyse
Put the head and neck in the sniffing position (flextension)
Get a good view (middle of the middle)
Slide a suitably small tube (6.0-6.5 mm ID for adults) along the blade into the trachea
And along the trachea (which is correctly aligned by flextension)

It’s not too tricky