How to Handle the Handle

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Steve Haywood
Former Respiratory Therapist working to de-mystify the ventilator through hands-on workshops and online education. Additional interests include HFNC in CHF and COPD, Medical Education, and Tupperware.

Pre-Brief

Do you hold the laryngoscope handle like an expert or novice? Many novices make the same mistakes when gripping the laryngoscope handle. When expert and novice proceduralists were observed intubating, clear differences were observed.

Where to hold?

An experienced proceduralist holds the laryngoscope handle closer to the hinge. The novice was noted to hold the handle much further from the hinge. Much like in sports, “choking up” on the handle gives you more control of the blade.

What to hold with?

An experienced proceduralist grips the laryngoscope handle more in the fingers whereas a novice grips more with the palm. When the handle is gripped in the fingers fine movements can be made. Gripping with the palm fine motor movements become more difficult.

How to manipulate? 

Experienced proceduralists were noted to keep the handle at an angle around 23.7 degrees compared to the table. If the handle is flexed to 45 degrees, the chances of causing dental trauma increases. Additionally, when the head is pulled into a proper “sniffing” position, the ideal view will be obtained more often.

The Debrief

  • An expert proceduralist holds the blade close to the hinge.
  • An expert proceduralist holds the handle more in the fingers than the palm
  • An expert proceduralist keeps the handle at an angle much less than 45 degrees when compared to the table.

References

  1. Zamora JE, Weber BJ, Langley AR, Day AG. Laryngoscope manipulation by experienced versus novice laryngoscopists. Can J Anaesth. 2014 Dec;61(12):1075-83. doi: 10.1007/s12630-014-0238-2. Epub 2014 Sep 13. PMID: 25216632.

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