At our institution--a tertiary teaching hospital--the default is to call ENT to "come down and scope them." However, if you're a DIY-minded emergentologist like us, that doesn't sit right. And why should it? While it has a bit of a learning curve it's a reasonably easy procedure that is definitely within our scope of practice (no pun intended).
Boring disclaimer: We will not be addressing fiberoptic intubations with this post. That is indeed an incredibly useful skill that despite the demand is not commonly mastered in our field in our time, but we'll tackle that barracuda at a different time.
To get started, you'll need to collect a few things. Obviously you'll need some sort of flexible endoscope, but you'll also want to get a hold of some 4% lidocaine and an atomizer for local anesthesia. Nebulized lidocaine or 5% cocaine are also options. You'll want to also use Afrin or Neo-Synephrine as an nasal decongestant as well.
And be liberal with these guys! You want them as comfortable as possible, so also give it time to work (we're talking 10-15 minutes, so go take care of other things for a spell while the meds take effect).
Allow the patient to sit up with their head free--you need to give them the ability to pull away in case you poke them in a turbinate. You also should be directly in front of the patient to accommodate a smooth passage
Lubricate the tip, and slowly advance under the inferior turbinate until you get to the soft palate. If you fog up at all, don't worry about a defogger--tapping the tip against mucosa will work just fine. At that point curve down, and after advancing a bit you should have a great view. You should clearly see any FB's or airway compromise. Make sure you see the entire structure, including the piriform sinuses. Check for mobility of the cords while having the patient say, "Eeeeeeee!"
When it's time to withdraw, make sure you come out gently, centering on the tissue so that you don't drag at all. Easy, right?!?!? Put it in your toolbox, because this one we can totally handle. However, and just as it is for any other procedure we write about here, this post is for EDUCATIONAL PURPOSES ONLY. Be smart!
jps
Sources:
Tom Ashfield's YouTube Page
Roberts and Hedges' Clinical Procedures in Emergency Medicine, 6th Edition. Chapter 63.
Airwaycam.com
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