Grandma made it back to Thanksgiving safe and sound. But now, alas, cousin Scooter, who seems oddly illiterate regarding his nut allergy, eats a bite of pecan pie. Thankfully, you have an epipen, inject his thigh, and save the day. However, he continues to complain about a throat swelling sensation so you take him to your ER.
[spacer height=”20px”]ENT is out for the holidays, so you are left performing your own flexible laryngoscopy because, guess what, it’s within our purview!
[spacer height=”20px”]So here’s your basic 101 on flexible scopes. We have a video scope at Elmhurst and I’m certain Dr. Rabinovich would love to teach anyone interested!
[spacer height=”20px”]ED uses:
angioedema
difficult airway
foreign body
stridor
epistaxis
cervicofacial trauma
[spacer height=”20px”]Equipment:
anti-fogging solution
lubricant
decongestant spray (phenylephrine, oxymetazoline)
anesthetic spray (4% lidocaine)
flexible nasolaryngoscope
thumb dial control
[spacer height=”20px”]Procedure:
1. Nasal sprays – decongestant followed by lidocaine
2. Dial control – hold the dial in your dominant hand; rotation of the dial will turn the flexible tip up or down; for your purposes, you will primarily keep the tip in neutral or down position; adjust as needed to view necessary structures
3. Enter the nasal passage guiding the flexible scope with your non-dominant hand, following along the inferior turbinate; essentially, stay as inferior as possible
4. As you pass the nasal airway, ask the patient to take a breath so as to open the passage into the oropharynx; adjust your dial as needed, generally you will be pointing down at this juncture
5. You are now in the larynx and should see epiglottis and cords
6. Assess for edema/abnormalities of the epiglottis, arytenoids, aryepiglottic folds, vocal cords, subglottic region, pyriform sinuses
7. Assess vocal cord function: Ask the patient to sniff through the nose to cause ABduction of the vocal cords, followed by saying “ah ah ah, ee, ee, ee” for ADduction of the cords
[spacer height=”20px”]Tips:
-Ask the patient not to swallow throughout exam
-Clear the lens by touching the nasopharynx
-When in doubt, retract the scope
[spacer height=”20px”]Two sweet videos from which I procured the majority of this information:
[spacer height=”20px”] image taken from www.alibaba.com
