Video laryngoscopes

[paramedicmike]

I think there is a hesitancy of some folks to become less practiced with direct laryngoscopy. The thought being that if the glide scope is over used, that DL skill will weaken. I don't buy it, but some might.

Residents in my ER are not allowed to use video laryngoscopy until PGY3 because of this very idea.  Get practiced with traditional laryngoscopy and then, after you get good at that, start rotating in the video tools.

[Off Label]

Residents in my ER are not allowed to use video laryngoscopy until PGY3 because of this very idea.  Get practiced with traditional laryngoscopy and then, after you get good at that, start rotating in the video tools.

depending on the device, ie, a vl with the same geometry as a standard dl device, residents can be trained without being allowed to view the screen, while the attending does see it.

On the downside, Ī don't think those vl's that resemble normal mac blades are as effective as the more exaggerated curved blades like the glide scope.

 

[ERDoc]

I always have the residents do DL first, except in trauma.  The glidescope is always at the bedside if needed.

[rock_shoes]

When dealing with a soiled/fluid airway it's often better to go in DL first to clear out the offending substance(s). If you were to go straight to VL you would just soil the thing and have no advantage over DL. That said, I have definitely gone in DL, cleared/suctioned the airway, then intubated VL after ventilating them up.

[1EMT-P]

I have tried most of the video based laryngoscopy devices, but to be honest with you none of the EMS agencies in my area currently carry the devices due. I have noticed that many of the Paramedics are using King Airways.

[Spock]

Thank you for the interesting comments.  I have to agree with most everything posted which makes this a dull topic.  My EMS service uses the King Vision and after a rough start, our first pass intubation success rate has improved by about 30%.  I've used just about all of the VL's and really like the second generation McGrath.  I do a lot of thoracic and esophageal cases in the OR and since I classify all of these patients as a difficult airway and high risk for aspiration, the VL seems the way to go.  

Those that argue VL will dilute DL skills are correct.  I struggle with new nurse anesthesia students on using VL at all since I can't help them if I can't see what they are seeing.  If I have a student that has had trouble with DL, I will use the McGrath in order to identify problems with their technique and remediate them.  We then go back to DL but sometimes I really wonder where we are going.  I would predict that in ten years, DL will be a lost art.  

This week in the OR was amusing.  Our chief of thoracic surgery was on vacation so I wound up doing regular surgical cases and I got out my miller 3 for each intubation.  The OR staff all laughed and asked if I remembered how to use a miller.  

There are pros and cons to advanced technology but I have to come down on using technology as much as possible even though I am an old fart and came into the computer age kicking and screaming and dragging my feet.  

I was surprised that nobody mentioned the cost of the VL devices.  

May the tube be with you.

Spock   

[BushyFromOz]

McGrath for me, the only VL I have ever had to use. We primarily use it as a training device for direct laryngoscopy when our IC students are in their on-road training phase. When I do an RSI and they look like they may be a difficult intubation, I have it out with the X-blade on as part of my failed drill setup and use a standard scope with a Mac 4 on it for pretty much everything