4 Using a straight blade direct laryngoscope. Find the epiglottis, then position the blade in the right side of the mouth, pivot the tip of the blade under the epiglottis, and advance slightly and then lift. Keep the proximal end of the blade in the extreme corner of the mouth (right paraglossal positioning). The small flange of the Miller design does not permit sweeping of the tongue. Moreover, the straight design does not allow pivoting back toward the center. Because of the shape of the dental arch, the straight blade (handle) can only pivot backwards if positioned all the way rightward (right on the right nostril).
Four Techniques for Handling the Omega-Shaped Epiglottis
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About the Author
Richard M. Levitan, MD, FACEP, is an adjunct professor of emergency medicine at Dartmouth’s Geisel School of Medicine in Hanover, N.H., and a visiting professor of emergency medicine at the University of Maryland in Baltimore. He works clinically at a critical care access hospital in rural New Hampshire and teaches cadaveric and fiber-optic airway courses.