First pass success depends on first pass anticipation of difficulty: Optimized bimanual Macintosh laryngoscopy and intubation

The difficult airway is often iatrogenic. Challenges may have nothing to do with the patient's intrinsic anatomy/pathology and are often the result of the clinician failing to optimize their approach. We are believers in mitigating issues before they arise instead of reacting to cues when your are stressed and your bandwidth is already maxed out. For Macintosh laryngoscopy (video or direct) here are some strategies that should be ROUTINE. Don't wait for shit to happen before you respond. Use both of your hands as part of optimized bimanual laryngoscopy and intubation on first attempt and train to do this in under 30 seconds. Separate video to come for hyperangulated VL.

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