INDIRECT LARYNGOSCOPY

A patient presents with severe sore throat. You wonder about epiglottitis. You know that using a mirror to look at the epiglottis is a great way to check this but are not confident in your skills. What do you need?

 

Dental mirror – they are cheap, have your ED stock them

 

Light – can use a headlamp, the kind that are sold in outdoor stores. Get one with a spot beam rather than a flood light. Nice to have regular AAA batteries instead of the medical ones with cords that are always getting lost or damaged

 

Relaxed patient – explain to them what you are doing and rehearse it once first

 

Anatomy – have them lean forward, chin out

 

View – wrap gauze around their tongue. Don’t pull it out but hold it so they don’t have to sustain muscle contraction to keep the tongue out

 

No gag – not sure topical anesthetics really work. Try to avoid hitting their pharynx with the mirror until you are ready to lift the uvula and look. Have the patient fix vision in the distance. Have them say “eeeeeee.” Have them do slow panting style shallow breathing.

 

No fog – hydrogen peroxide or hot water will help prevent fogging

 

You look and it is hard to see. That reminds us the final thing you need – practice!

 

TAKE HOME POINTS

-Indirect laryngoscopy is a complex hand-eye skill that you can learn

-Get the right supplies and start doing this now. It may really help you one day.

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