George Kovacs, MD, MHPE, an emergency physician from Halifax, Nova Scotia, and director of the Airway Interventions & Management in Emergencies (AIME) courses, introduced the “Kovacs’ sign” of hyperangulated blades (see Figures): if the blade is overinserted, the cricoid ring becomes visible between the vocal cords. This indicates a very steep angle of approach and will likely make tube introduction difficult. Conversely, when the angle of approach is not so steep, the cricoid ring is not seen, there is more room between the blade tip and the larynx, and there will be more space on the inferior aspect of the monitor to observe tube delivery.
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