OTOLARYNGOLOGISTS have a particular advantage in medical crisis in that the technique of direct laryngoscopy is an inherent part of their education and skill.
Paluel Flagg, MD, and R. M. Hosler* have called attention to the fact that "when respiration and pulse disappear the mucous membranes of the lips and conjunctiva become a deep purple, the skin a bluish grey."
They note that if the heart has stopped beating, intubation and oxygen insufflation produce no change in color. On the other hand, if the heart is beating, intubation and oxygen insufflation produce an almost instantaneous change in color.
Intubation is not difficult at this moment of crisis, because the consensus of opinion holds that when the heart stops beating or goes into fibrillation, muscle tone and reflexes promptly disappear. In these relaxed circumstances, the otolaryngologist with his inherent skill has no problem in exposing the larynx for tracheal intubation.
HILGER J. Laryngoscopy. Arch Otolaryngol. 1966;83(6):514. doi:10.1001/archotol.1966.00760020516002
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