Rapid Responses to:

ANAESTHESIA:
Chris Johnson and Neville W Goodman
Time to stop sniffing the air: snapshot survey
BMJ 2006; 333: 1295-1296 [Abstract] [Full text]
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[Read Rapid Response] Stop sniffing, start ramping
Andrew K Bacon   (31 December 2006)

Stop sniffing, start ramping 31 December 2006
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Andrew K Bacon,
Anaesthetist
St John of God Hospital, Berwick, Australia 3806

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Re: Stop sniffing, start ramping

I agree completely with the results of the short survey. I direct readers to the article below which I have found to work superbly in practice in patients without head or neck trauma. From memory the concept first appeared as 'ramping up' in an US emergency medicine article, but the beauty is the simplicity and objectivity of the horizontal line from the external auditory meatus to suprasternal notch. The following is my working script for trainees and ambulance paramedics, being simple enough for all grades of staff to ensure that the patient is positioned correctly. 1) Patient supine, 2) Arrange pillows under the head to achieve a horizontal line from the external auditory meatus to suprasternal notch. 3) If necessary in the very obese be prepared to ramp even more pillows/blankets under the upper thoracic spine to get the position right. 4) Always have the thumb of the left hand slightly to the left of centre parallel to the handle (ie off centre, similar to a golf grip). 5) If the anterior upper chest wall obstructs insertion of the laryngoscope, with the tip of the blade over the mouth, turn the laryngoscope handle clockwise until the base is approximately over the acromio-clavicular joint. Gently insert the blade to the right of the tongue and as the tip moves posteriorly rotate the handle back to a normal position, gliding clear of the chest wall.

Authors: Jeremy S. Collins; Harry J.M. Lemmens; Jay B. Brodsky; John G. Brock-Utne; Richard M. Levitan

Source: Obesity Surgery, Volume 14, Number 9, October 2004, pp. 1171- 1175(5)

Publisher: FD Communications Inc.

Competing interests: None declared