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Tomahawk Intubation:
Tomahawk intubation, also known as "face-to-face", "inverse", or "pickaxe" intubation, is a technique for intubating patients who cannot be safely placed in a supine position.
It involves intubating the patient from the front while they are seated upright, making it ideal for patients with pulmonary edema, obesity, low oxygen saturation, or dynamic airway obstruction.
The key steps of Tomahawk intubation are:
1. Enlist a colleague to stabilize the patient's floppy head, which lacks control in a coma or after sedation.
2. Hold the laryngoscope in your right hand to avoid crossing your arms.
3. Manipulate the scope with your right hand while passing the tube with your left hand.
4. A video laryngoscope may be used for better visualization.
5. Position the patient's head slightly lower than your own to better control the endotracheal tube as you pass it through the vocal cords.
6. A bougie can be used to facilitate the insertion of the endotracheal tube into the trachea.
This video demonstrates the key steps of Tomahawk intubation.
1. A colleague helps stabilize the patient's floppy head.
2. The intubator holds the laryngoscope in his right hand to avoid crossing his arms.
3. The intubator manipulates the video laryngoscope with his right hand while passing the tube with his left hand.
4. The patient's head is positioned slightly lower than the intubator's eye level for better control of the endotracheal tube during intubation.
This video demonstrates prehospital Tomahawk intubation which involves a bougie.
This technique is classically used for entrapment cases where the patient's airway needs to be secured, but the victim is unable to be positioned supine or extricated.
In this case, a bougie was used to facilitate the insertion of the endotracheal tube into the trachea.
Tomahawk intubation is often performed with video laryngoscopes, but can also be done with flexible fiberoptic laryngoscopes in awake patients[5]. It allows intubating patients who cannot be laid supine, while keeping airway secretions away from the camera lens.