title: Rescuer position for tracheal intubation on the ground.
abstract: BACKGROUND
  Emergency oral tracheal intubations in the pre-hospital setting can be more difficult because the rescuer's position with respect to a patient lying on the ground may not provide optimal conditions for intubation. Since optimal visualisation of the larynx often depends on the force generated during laryngoscopy, we measured the pressure required for intubation (P(i)) as well as the maximum pressure (P(max)) that can be generated with the laryngoscopy blade in seven intubator positions.
  
  
  METHODS
  Nineteen hospital personnel with intubation experience participated in this study. A modified #3 Macintosh laryngoscope blade was used to measure the pressure exerted on the tongue of a manikin placed on the ground during intubation. The following positions were studied: standard, sitting, prone, kneeling, left and right lateral decubitus and straddling.
  
  
  RESULTS
  Intubating in the straddling position required the lowest P(i), as a percent of P(max) (68+/-14%). This was significantly less than the prone, right lateral decubitus and sitting positions. (Tukey's W procedure, P<0.05)
  
  
  CONCLUSIONS
  The straddling position affords the intubator significantly more reserve force than the prone, right lateral decubitus or sitting position. We suggest that the straddling position may be an advantageous position for pre-hospital intubations especially when visualisation of the glottis is difficult.
authors.affiliation: Department of Anaesthesia, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 3 EN-424, Toronto, Ont, Canada M5G 2C4. j.tesler@utoronto.ca
authors.forename: Janet
authors.initials: J
authors.lastname: Tesler
authors.forename: Joshua
authors.initials: J
authors.lastname: Rucker
authors.forename: Danny
authors.initials: D
authors.lastname: Sommer
authors.forename: Alex
authors.initials: A
authors.lastname: Vesely
authors.forename: Stuart
authors.initials: S
authors.lastname: McClusky
authors.forename: Katharina P
authors.initials: KP
authors.lastname: Koetter
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Maleck
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Fisher
authors.forename: Georg A
authors.initials: GA
authors.lastname: Petroianu
mesh_terms: D000328:Adult; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D008875:Middle Aged; D011187:Posture; D011312:Pressure