Hyperangulated intubation (e.g., GlideScope Lopro or Storz D-blade)

Steps

1. Prepare for intubation.

2. Open the patient’s mouth with your right hand (scissor technique or push chin down).

3. While looking at the patient’s mouth and holding the scope with your left hand, introduce the blade into the patient’s mouth. Keep the blade in the midline of the tongue throughout the procedure (no need to sweep the tongue).

4. Direct attention to the video monitor as you slowly advance the blade.

5. Once you identify the epiglottis, place the blade in the vallecula.

6. Gently lift and identify the vocal cords. Manipulate the blade as needed to obtain the best glottic view (glottis centered in the top half of the screen).

7. Pass the styleted tube through the mouth and posterior pharynx under direct visualization of the mouth.

8. Looking at the monitor, watch for the tip of the tube to appear.

9. Direct the tube through the vocal cords while using your right thumb to detach the tube from the stylet. The stylet should be stationary and should not pass through the vocal cords.

10. Have an assistant remove the dislodged stylet.

11. Remove the blade.

12. Inflate the endotracheal tube cuff.

13. Connect to a bag-valve-mask and begin ventilation.

14. Confirm proper placement with end-tidal CO₂ detection, auscultation, tube misting, and chest rise.

15. Secure the tube. Note depth via numbers on tube at the patient’s central incisors.