Hyperangulated intubation

  1. Formulate and verbalize an acceptable difficult airway plan (e.g., supraglottic device next, cric if unable to intubate or ventilate)
  2. Prepare equipment correctly (either rigid stylet in tube or standard stylet with tube bent to mirror shape of the hyperangulated blade)
  3. Looking in the mouth, insert the hyperangulated blade at the midline of oropharynx
  4. Looking at the monitor, advance the blade and identify the epiglottis
  5. Manipulate the blade to obtain the best glottic view (glottis in middle and top half of screen, enough distance to allow a wide field of view)
  6. Looking in the mouth, guide the distal tip of the tube into position near the tip of the laryngoscope
  7. Looking at the monitor, advance the tube to the glottic opening (partially withdraws stylet to direct the tube tip anteriorly if needed)
  8. Advance the tube over the stylet and into the glottic opening, past the vocal cords
  9. Remove stylet
  10. Bag patient and confirm placement (misting, breath sounds, continuous end-tidal CO2)