(A) The patient's mandible and tongue are retracted anteriorly with the nondominant hand. Using the dominant hand, the operator inserts the scope and endotracheal tube into the center of the patient's mouth and advances them over the tongue.
(B) While looking through the eyepiece, the operator advances the stylet and endotracheal tube beneath the epiglottis and into the glottic opening.
(C) The endotracheal tube is released from the adjustable stop and passed over the stylet into the proper position.
(D) The stylet is carefully removed, with care taken not to dislodge the endotracheal tube.
Reproduced with permission from: King BR, Hagberg CA. Management of the difficult airway. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King C, Henretig FM (Eds). Lippincott Williams & Wilkins, Philadelphia 2008. Copyright © 2008 Lippincott Williams & Wilkins.
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