RRivas2004 Posted January 11, 2015 Share Posted January 11, 2015 As this is my first job in the ER I've been given a few chances over the last 5 months to attempt intubation with the attending at the bedside on various patients. Mostly I was using the Glide Scope so I could show the attending I was visualizing the vocal cords. I believe I tried 4 times in total with the glide scope, each time I had much difficulty manipulating the tube and getting it to go where I wanted, and mind you I have a lot of laparoscopic/Robotic surgical experience prior to EM. Today I had another chance and tried with regular ole' Mac 4 and I had a MUCH easier time. Nailed it first shot. Should I chalk it up to just learning from my failures, or is the glidescope just inherently more difficult for everyone? I have been trying to get the respiratory therapy department to let me practice on their mannequins using the glidescope in hopes of getting better. I am also looking into an airway course in the near future to help advance my skills. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 11, 2015 Moderator Share Posted January 11, 2015 I am not a big fan of the glidescope either. much prefer a mac or miller or the kingview video laryngoscope which has the screen right on the handle. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 11, 2015 Moderator Share Posted January 11, 2015 glidescope requires that you totally 100% can visualize in your head all the anatomy and what it looks like on that little screen, then while looking away, move you hands in the right way...... this is typcially something you either have or need to learn. It is a strange ability not really tested in other parts of medicine, except maybe in your robitics side. And I think some of it is just how your brain is wired practice with anesthesia doe airway course Link to comment Share on other sites More sharing options...
gbrothers98 Posted January 11, 2015 Share Posted January 11, 2015 Make sure you are using rigid stylet with ET. If not, you wont be able to move that tube to save anyone's life. Also, still have to make sure you are still positioning pt well, aligning axis, ear lobe in line with sternal notch. When using the glidescope, dont do anything more than place the scope. Dont lift up and only make minute adjustments. Better to have an assistant do BURP for you or just some old fashioned sellick's to see if can improve view. See if you can get in and do some intubation in the OR with the glidescope. Usually just need more practice to become proficient. Good luck. G Brothers PA-C Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 11, 2015 Moderator Share Posted January 11, 2015 This is the one we use at my rural per diem job: http://www.kingsystems.com/medical-devices-supplies-products/airway-management/video-laryngoscopes/ I like it better than the glidescope because the screen is right on the scope. Link to comment Share on other sites More sharing options...
dmdpac Posted January 11, 2015 Share Posted January 11, 2015 I've used a glidescope multiple times without a problem. As mentioned it takes a bit of a disconnect between what you're seeing on the screen and what you need to make your hands do in order to place the tube. The best way to get better is to practice practice practice. Getting into a sim lab will be beneficial to you. Taking an airway course will also be beneficial. Proficiency with video and direct laryngoscopy is something that will prove useful to you if you find you'll be intubating on a somewhat regular basis. Knowing the equipment that you will be using (and will have on hand in your facility), and knowing it inside and out, is one of the keys to airway success. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 11, 2015 Moderator Share Posted January 11, 2015 I've used a glidescope multiple times without a problem. As mentioned it takes a bit of a disconnect between what you're seeing on the screen and what you need to make your hands do in order to place the tube. The best way to get better is to practice practice practice. Getting into a sim lab will be beneficial to you. Taking an airway course will also be beneficial. Proficiency with video and direct laryngoscopy is something that will prove useful to you if you find you'll be intubating on a somewhat regular basis. Knowing the equipment that you will be using (and will have on hand in your facility), and knowing it inside and out, is one of the keys to airway success. the problem is most folks only reach for the glidescope or kingview once they have failed using a mac or miller so we are talking maybe 10% of attempts if that. and if you only use video you forget how to use mac/miller which are the more critical skills to maintain. what if the glidescope is broken? Link to comment Share on other sites More sharing options...
dmdpac Posted January 11, 2015 Share Posted January 11, 2015 I agree. That's why proficiency with both is important as I mentioned above. This is also where getting into the sim lab, if available, or some sort of practice environment will help in developing that proficiency in both direct and video laryngoscopy. Link to comment Share on other sites More sharing options...
RRivas2004 Posted January 11, 2015 Author Share Posted January 11, 2015 I definitely will get into the sim lab soon. I am considering the airway course in Baltimore, MD If anything I wish my department would invest in some better lights for the mac/miller blades. Perhaps LED?? The current ones are faint yellow lights, even with fresh batteries and bulbs. I think alot of my problem is that I didn't have an anesthesiology rotation during school, and no chances to intubate during my ER rotations. Just happy to be in a place where I'm getting great mentorship. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted January 11, 2015 Moderator Share Posted January 11, 2015 Make sure you are using rigid stylet with ET. If not, you wont be able to move that tube to save anyone's life. Also, still have to make sure you are still positioning pt well, aligning axis, ear lobe in line with sternal notch. Good luck. G Brothers PA-C Very very very important- heed this advice! Anything that takes you away from directly visualizing what you're trying to see, even if it's a video of what you're trying to see, is inherently going to make your time a bit more difficult. A lesser-used ER technique but similar in difficulty is the fiberoptic nasopharyngolaryngoscopy which I was taught to do while visualizing the big TV screen that it plugged into- not only was the anatomy backwards from what you saw on the screen, but you're also facing the patient so the axis is the opposite. Link to comment Share on other sites More sharing options...
SurraMova Posted January 11, 2015 Share Posted January 11, 2015 Really appreciate you sharing this article post.Really thank you! Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 11, 2015 Moderator Share Posted January 11, 2015 Two biggest problems I see people make is not using the rigid styler that comes with the glide scope. It's important because the glide scope blade is a different angle than you'll be use to with the Mac. Second, people are not gripping the T piece and instead holding it like they were doing a DL with a normal stylet. Why that matters I'm not sure, but once that is corrected I've seen people have significant improvement in their glide scope skills. - former anesthesia Link to comment Share on other sites More sharing options...
RRivas2004 Posted January 22, 2015 Author Share Posted January 22, 2015 Update: A few shifts after my original post I did get another chance with a frail elderly woman with respiratory failure. Nailed it first shot with the traditional MAC 4. And tonight, a much better one... Obese, overdose, aspirating plenty of vomit and oral secretions, nailed it with the glide scope. I managed to correct my technique with the glidescope by borrowing the Resp Therapists intubation mannequin and practicing for several hours. Hard work pays off. Link to comment Share on other sites More sharing options...
whoRyou Posted January 22, 2015 Share Posted January 22, 2015 Update: A few shifts after my original post I did get another chance with a frail elderly woman with respiratory failure. Nailed it first shot with the traditional MAC 4. And tonight, a much better one... Obese, overdose, aspirating plenty of vomit and oral secretions, nailed it with the glide scope. I managed to correct my technique with the glidescope by borrowing the Resp Therapists intubation mannequin and practicing for several hours. Hard work pays off. Practice makes perfect! Link to comment Share on other sites More sharing options...
JMann Posted January 30, 2015 Share Posted January 30, 2015 Nice job Rivas! Link to comment Share on other sites More sharing options...
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