Airway Management - Training - SOS Pearls

SOS (Shikani Optical Stylet)

Tips from the experts

(For medical professionals only)

Caution: The following are suggestions for medical professionals who have been properly trained to perform intubations and who have thoroughly studied the DFU. The following suggestions may or may not apply to your patient or to the situation at hand. Follow your own medical judgment at all times.

1. Equipment set-up:

• Short “hockey-stick” {70-90 degrees} configuration
• Load endotracheal tube onto stylet and lubricate
• Have tip of scope 2-5 mm inside tip of ET tube
• Have suction available
• Connect oxygen at greater than 5L/min
• Turn light on

2. After patient is induced and paralyzed:

• Position in usual sniffing position
• Lift jaw upwards with your left hand; may want to lift tongue with 4x4
• Manipulate instrument with right hand

3. Insert SOS stylet gently and aim tip towards glottis:

• Pitfall alert: Common error is to insert tip in too far, usually in esophagus. Other “never land” position is in pyriform sinus lateral to glottis.
• Preferably identify epiglottis—epiglottis is your landmark or point of reference.
• Either go under epiglottis or sometimes it is easier to go around epiglottis.
• Once you’ve bypassed the epiglottis, you should easily visualize vocal cords.
• If you cannot identify discernible landmarks e.g., epiglottis, vocal cords, trachea rings, then back up and start over again. You may need to get the neck more extended or turn on the oxygen if you haven’t already done so.
• Advance just past the glottis and then advance ET tube over the stylet into trachea and watch as tube advances into the trachea.
• ET tubes often get locked at this point. Pull out stylet while holding ET tube in position, and then attempt to maneuver the ET tube into the final position {21-25 cm for adults}. Confirm ET carbon dioxide.
  

Mandible and tongue are retracted anteriorly with left hand. The scope with ETT is introduced into the mouth in the center and advanced over the surface of the tongue.

The stylet with ETT is advanced into the glottis under direct vision.

The ETT is released from adjustable tube stop.

The ETT is placed in the tracheal lumen over the stylet.