Trick of the Trade: Laryngoscope Lifting Strength


Intubation of mannequin

You are about to endotracheally intubate a patient. As you struggle to elevate the laryngoscope more anteriorly, has your left hand ever trembled while trying to see the vocal cords? Before you say, “I think the cords are too anterior, hand me the [insert your favorite backup airway adjunct]“, let’s focus on some basics.

How can you gain significantly more laryngoscope lift strength? You can do more left arm bicep/tricep exercises, or…

Trick of the Trade
Hold the laryngoscope handle as close to the blade as possible.

Grabbing part of the blade helps to stabilize against the “waggling” of the handle. Furthermore, it is easier to pull exactly along the long-axis of the handle at this grip point. I would avoid holding the laryngoscope handle as shown in the image above. Is the physician intubating or holding a fragile cup of tea?

Proper holding of larynoscope handleThe most stabilizing larngyoscope grip
which provides maximal lift strength.

For other airway Tricks of the Trade, take a look an older post.

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  1. #1 by Patrick - December 16th, 2009 at 23:11

    You want the maximum in lifting strength, try a third hand: http://codebluemedical.com/Services.html

  2. #2 by Carey - December 18th, 2009 at 18:03

    Great tip, thank you. But if you’re partial to the weight training approach, don’t forget to train the anterior deltoids.

    Those of you that have played some hacky-sack will know why I like to call the sartorius muscle the “hacky-sack muscle.” Now, I call the anterior deltoids the “intubation muscle.”

  3. #3 by Michelle - December 19th, 2009 at 03:48

    Hi Carey and Patrick: Thanks for the comments. I think we should require anterior deltoid muscle strength assessment during residency interview season. Weak left anterior deltoid means dropping the applicant down a few notches on the rank list!

  4. #4 by Carey - December 23rd, 2009 at 20:07

    Excellent suggestion.

    There’s no worse way for a resident to fail the “night shift test” than to not be strong enough to lift a patient’s anterior neck soft tissues high enough to visualize the cords at 3 am. He/she might be a witty conversationalist, but….

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