Introduction

Tracheal intubation by direct laryngoscopy is a bread and butter procedure for emergency medicine physicians. Our goal, get plastic in the trachea. Success during this procedure is largely predicted by our setup in terms of patient positioning and pre-oxygenation, as well as patient factors that make visualization of the vocal cords more difficult.

In an anticipated difficult airway, we often prepare by having alternative airway adjuncts available in case our initial attempt fails. However something simple such as manipulation of the larynx externally can possibly make a difficult airway an easy one and avoid multiple attempts or prolonged apnea time.

Don't forget that you have two hands, one holding the laryngoscope, the other freely available to manipulate the larynx at will. This isn't cricoid pressure, this isn't BURP (backwards upwards pressure). This is manipulating the larynx in any way you can during laryngoscopy to maximize your view of the cords. This ladies and gentleman, is bimanual laryngoscopy...and it works.