Vieo Laryngeoscopy

[croaker260]

For those of you that have these devices, or have trialed them:

What make/model are you guys using in your individual services, what guidelines do you have for their use, and any lessons learned from your experiance?

[paramedicmike]

I've used the Glide Scope and CMAC in the field. My old service uses the Glide Scope. My ER has the CMAC (but the OR as the Glide Scope... go figure).

My old service now mandates that all first attempts be made with video laryngoscopy.

My ER mandates that the CMAC be used but residents need to use it as a traditional laryngoscope first before becoming reliant on the video feed (attendings monitor the video during the attempt).

Intubations I've done in the ER have been with the old fashioned laryngoscope.

The Glide Scope take some getting used to and changing of some muscle memory. Overall, though, it was an easy device to learn. Both have a learning curve in terms of handle/blade placement. If the tip of either device is inserted too close to the pharynx it'll deflect the tube downward and you won't be able to intubate the trachea. As you have no depth perception on the monitor determining whether or not you're too close can be tricky.

Despite the "no fog" claims there is still the chance of fogging. And it'll always happen at the worst possible time.

One advantage to the CMAC was that you could capture images of your tube placement to verify it was in the correct location and then attach them to your chart. That's a nice feature to have.

Ultimately, I do like video laryngoscopy. I would like to see more widespread use of the devices. They are expensive, though. We'll see how that works out.

[rock_shoes]

My service just started to carry the King Vision

http://www.kingsystems.com/medical-devices-supplies-products/airway-management/video-laryngoscopes/

So far it has been brilliant. Medical programs is recommending its use with any anticipated difficult airway, and with all second attempts (unsuccessful first pass). The technique is somewhat different from direct laryngoscopy but quite easy to pick up. A solid afternoon with some instruction and an airway dummy is more than enough to pick up on the technique for any experienced intubator. Blades are available with or without a chanel necessitating two slightly different techniques.

[ERDoc]

Putting the costs aside, I think in the field is where the most benefit would come from. There is article after article that says EMS providers cannot reliably intubate (let's not debate that here). Video scopes make some of the most difficult tubes real easy. I've used the glidescope and the McGrath. Both work well, though the early McGraths had some issues that they have fixed.

[BushyFromOz]

We just covered this last week in class, basically we do not have the stats to make the argument for video over direct laryngoscopy as our success rates equal those of emergency department physicians already. The other thing is the cost, we would need 130 something units.

[rock_shoes]

We just covered this last week in class, basically we do not have the stats to make the argument for video over direct laryngoscopy as our success rates equal those of emergency department physicians already. The other thing is the cost, we would need 130 something units.

Interesting. My service also has DL success rates similar to the typical emergency department. They elected to bring them in anyway thanks to evidence based pressures from the medical leadership (first pass success being clearly linked to improved patient outcomes).

[BushyFromOz]

Interesting. My service also has DL success rates similar to the typical emergency department. They elected to bring them in anyway thanks to evidence based pressures from the medical leadership (first pass success being clearly linked to improved patient outcomes).

I know man, ive been coming across articles and examples in the last few weeks that have been used to justify the introduction of one piece of equipment / drug procedure in one EMS system, and then used to no introduce the same piece of equipment / drug / procedure in another area. Very interesting stuff!