medic25 Posted July 24, 2011 Author So I finally got to perform my first GlideScope intubation last night, and I'm officially now a fan. Obese male presented via EMS in cardiac arrest, s/p failed field intubation attempt. I attempted DL with my usual Mac 3 and was briefly able to visualize the cords when I performed the BURP maneuver, but couldn't keep it in view long enough to pass a tube. My attending took the next look and had similar success. I took the next attempt with the GlideScope, and very quickly had a great view of the vocal cords and easily passed the ET tube. Afterwards, I got to wondering if anyone was using the GlideScope (or a similar device) for all of their intubations, or if it's simply reserved for the failed or difficult airway. We usually only get it out when things get hairy, but I could see an argument being made for the fiberoptic approach being a new standard of care, just like ultrasound has replaced the DPL in trauma. What are the odds that in 10 years we'll be doing all of our airway management with a GlideScope?
medic25 Posted July 24, 2011 So I finally got to perform my first GlideScope intubation last night, and I'm officially now a fan. Obese male presented via EMS in cardiac arrest, s/p failed field intubation attempt. I attempted DL with my usual Mac 3 and was briefly able to visualize the cords when I performed the BURP maneuver, but couldn't keep it in view long enough to pass a tube. My attending took the next look and had similar success. I took the next attempt with the GlideScope, and very quickly had a great view of the vocal cords and easily passed the ET tube. Afterwards, I got to wondering if anyone was using the GlideScope (or a similar device) for all of their intubations, or if it's simply reserved for the failed or difficult airway. We usually only get it out when things get hairy, but I could see an argument being made for the fiberoptic approach being a new standard of care, just like ultrasound has replaced the DPL in trauma. What are the odds that in 10 years we'll be doing all of our airway management with a GlideScope?
Administrator rev ronin Posted July 24, 2011 Administrator In 10 years? I suspect 5 will be plenty. In my surgery rotation I saw perhaps 10% of the intubations done with a glidescope or bronchoscope., but it seems like a no-brainer to have multi-person confirmation that the tube has passed the cords.
Administrator rev ronin Posted July 24, 2011 Administrator In 10 years? I suspect 5 will be plenty. In my surgery rotation I saw perhaps 10% of the intubations done with a glidescope or bronchoscope., but it seems like a no-brainer to have multi-person confirmation that the tube has passed the cords.
acozadd Posted July 24, 2011 In 10 years? I suspect 5 will be plenty. In my surgery rotation I saw perhaps 10% of the intubations done with a glidescope or bronchoscope., but it seems like a no-brainer to have multi-person confirmation that the tube has passed the cords. 5 seems pretty quick for something that is quite costly. Ive seen it used once in my surgery rotation, only for a difficult intubation. Im at a major level 1 trauma center with plenty of cash to go around for things like this as well.
acozadd Posted July 24, 2011 In 10 years? I suspect 5 will be plenty. In my surgery rotation I saw perhaps 10% of the intubations done with a glidescope or bronchoscope., but it seems like a no-brainer to have multi-person confirmation that the tube has passed the cords. 5 seems pretty quick for something that is quite costly. Ive seen it used once in my surgery rotation, only for a difficult intubation. Im at a major level 1 trauma center with plenty of cash to go around for things like this as well.
nightrt Posted July 24, 2011 We have had it available at our facility for about 1 year, used it twice in that time. We anticipated the need for it on one occasion and had to hunt it down for the other.
nightrt Posted July 24, 2011 We have had it available at our facility for about 1 year, used it twice in that time. We anticipated the need for it on one occasion and had to hunt it down for the other.
Acebecker Posted July 24, 2011 I work rural EMS when I'm not in clinical rotations (graduate in 5 weeks) and in the ED we use GlideScopes 100% of the time now that we have it available. We are going to be getting one that we will carry on our quick response rig for difficult airways. We just used the GlideScope today, in fact, on a patient that would have otherwise been quite difficult to intubate. Slick as a whistle. Andrew
Acebecker Posted July 24, 2011 I work rural EMS when I'm not in clinical rotations (graduate in 5 weeks) and in the ED we use GlideScopes 100% of the time now that we have it available. We are going to be getting one that we will carry on our quick response rig for difficult airways. We just used the GlideScope today, in fact, on a patient that would have otherwise been quite difficult to intubate. Slick as a whistle. Andrew
Contrarian Posted July 24, 2011 Its a great tool and I love it... I just hope there is incentive to maintain standard intubation skillz... cause when the scope breaks, batteries die, power is out or the thing is somehow rendered unserviceable... somebody in the room will need to know how to advance that tube....
Contrarian Posted July 24, 2011 Its a great tool and I love it... I just hope there is incentive to maintain standard intubation skillz... cause when the scope breaks, batteries die, power is out or the thing is somehow rendered unserviceable... somebody in the room will need to know how to advance that tube....
dreamin2baPA Posted July 24, 2011 Its a great tool and I love it...I just hope there is incentive to maintain standard intubation skillz... cause when the scope breaks, batteries die, power is out or the thing is somehow rendered unserviceable... somebody in the room will need to know how to advance that tube.... Amen Contrarian! I am a faculty member of an airway mgmt course and we encourage experienced laryngoscopists to use video assisted laryngoscopy for high success rates. I agree with you on standard laryngoscopy equipment. Hospital may not have video assist, may not be available, or may not be functional. We should all be proficient with various ETI methods. However, I am still not crazy about digital w/o bite blocks.......
dreamin2baPA Posted July 24, 2011 Its a great tool and I love it...I just hope there is incentive to maintain standard intubation skillz... cause when the scope breaks, batteries die, power is out or the thing is somehow rendered unserviceable... somebody in the room will need to know how to advance that tube.... Amen Contrarian! I am a faculty member of an airway mgmt course and we encourage experienced laryngoscopists to use video assisted laryngoscopy for high success rates. I agree with you on standard laryngoscopy equipment. Hospital may not have video assist, may not be available, or may not be functional. We should all be proficient with various ETI methods. However, I am still not crazy about digital w/o bite blocks.......
Administrator rev ronin Posted July 24, 2011 Administrator 5 seems pretty quick for something that is quite costly. Ive seen it used once in my surgery rotation, only for a difficult intubation. Im at a major level 1 trauma center with plenty of cash to go around for things like this as well. Think of it from a risk management perspective: "Could you please tell the court why you did not use the GlideScope to secure my client's airway, even when you had this tool at your disposal?" (or: failed to procure such a tool when it was clearly available on the market and multiple other similar-sized hospitals have and use them) Unless there's major tort reform between now and then, come find me in 2016 and I'll be happy to buy you a beverage of your choice if the GlideScope or other visual technology assisted intubation technologies haven't become standard of care by then.
Administrator rev ronin Posted July 24, 2011 Administrator 5 seems pretty quick for something that is quite costly. Ive seen it used once in my surgery rotation, only for a difficult intubation. Im at a major level 1 trauma center with plenty of cash to go around for things like this as well. Think of it from a risk management perspective: "Could you please tell the court why you did not use the GlideScope to secure my client's airway, even when you had this tool at your disposal?" (or: failed to procure such a tool when it was clearly available on the market and multiple other similar-sized hospitals have and use them) Unless there's major tort reform between now and then, come find me in 2016 and I'll be happy to buy you a beverage of your choice if the GlideScope or other visual technology assisted intubation technologies haven't become standard of care by then.
Just Steve Posted July 24, 2011 They are making their way into pre hospital settings as well. Port of Portland Fire department has 2 I believe.
Just Steve Posted July 24, 2011 They are making their way into pre hospital settings as well. Port of Portland Fire department has 2 I believe.
dreamin2baPA Posted July 24, 2011 Think of it from a risk management perspective: "Could you please tell the court why you did not use the GlideScope to secure my client's airway, even when you had this tool at your disposal?" (or: failed to procure such a tool when it was clearly available on the market and multiple other similar-sized hospitals have and use them) Unless there's major tort reform between now and then, come find me in 2016 and I'll be happy to buy you a beverage of your choice if the GlideScope or other visual technology assisted intubation technologies haven't become standard of care by then. Rev: Some CAH don't have the $ in the budget. However, there are other, very less expensive devices that have good success rates. AND, many forget the simple/inexpensive, yet elegant bougie.
dreamin2baPA Posted July 24, 2011 Think of it from a risk management perspective: "Could you please tell the court why you did not use the GlideScope to secure my client's airway, even when you had this tool at your disposal?" (or: failed to procure such a tool when it was clearly available on the market and multiple other similar-sized hospitals have and use them) Unless there's major tort reform between now and then, come find me in 2016 and I'll be happy to buy you a beverage of your choice if the GlideScope or other visual technology assisted intubation technologies haven't become standard of care by then. Rev: Some CAH don't have the $ in the budget. However, there are other, very less expensive devices that have good success rates. AND, many forget the simple/inexpensive, yet elegant bougie.
medic25 Posted July 24, 2011 Author Amen Contrarian! I am a faculty member of an airway mgmt course and we encourage experienced laryngoscopists to use video assisted laryngoscopy for high success rates. I agree with you on standard laryngoscopy equipment. Hospital may not have video assist, may not be available, or may not be functional. We should all be proficient with various ETI methods. However, I am still not crazy about digital w/o bite blocks....... Agreed with both you guys. I would hate to see the traditional techniques be forgotten. We've had similar discussions in the past about blind nasotracheal intubation. None of our residents coming through these days have ever known a world without RSI, and have never seen (let alone performed) a nasal tube. While I would much prefer to paralyze before intubation, it's nice to know that I've dropped a few nasal tubes in the past and if push came to shove I could pull it out of my back pocket. I'm with you on the digital intubation though; I tried it once years ago, but my fingers would appreciate never trying it again :)
medic25 Posted July 24, 2011 Author Amen Contrarian! I am a faculty member of an airway mgmt course and we encourage experienced laryngoscopists to use video assisted laryngoscopy for high success rates. I agree with you on standard laryngoscopy equipment. Hospital may not have video assist, may not be available, or may not be functional. We should all be proficient with various ETI methods. However, I am still not crazy about digital w/o bite blocks....... Agreed with both you guys. I would hate to see the traditional techniques be forgotten. We've had similar discussions in the past about blind nasotracheal intubation. None of our residents coming through these days have ever known a world without RSI, and have never seen (let alone performed) a nasal tube. While I would much prefer to paralyze before intubation, it's nice to know that I've dropped a few nasal tubes in the past and if push came to shove I could pull it out of my back pocket. I'm with you on the digital intubation though; I tried it once years ago, but my fingers would appreciate never trying it again :)
jwk Posted July 24, 2011 We've used GlideScopes in the OR for several years now. They are da bomb. Get the model with the reusable camera and disposable blades. Using a fairly rigid stylet helps a lot. Our ETT's come pre-packaged with a stylet that's not worth a crap with the GlideScope. The biggest downside to using them for every intubation is that you lose your skills on doing DL's the old-fashioned way. They do NOT guarantee that you will get the tube in every time. These devices are not generally available in every OR, ER, ICU, or crash cart, so there will always be times you have to be able to do a DL with a regular laryngoscope and blade(s) of choice. A GlideScope does not make you an airway expert.
jwk Posted July 24, 2011 We've used GlideScopes in the OR for several years now. They are da bomb. Get the model with the reusable camera and disposable blades. Using a fairly rigid stylet helps a lot. Our ETT's come pre-packaged with a stylet that's not worth a crap with the GlideScope. The biggest downside to using them for every intubation is that you lose your skills on doing DL's the old-fashioned way. They do NOT guarantee that you will get the tube in every time. These devices are not generally available in every OR, ER, ICU, or crash cart, so there will always be times you have to be able to do a DL with a regular laryngoscope and blade(s) of choice. A GlideScope does not make you an airway expert.
FriarMedic Posted July 24, 2011 We carry it pre-hospital and its used typically for difficult airways or poss cervical injury to limit manipulation. I actually find it a little more tricky to use pre-hospital trying to balance the video screen in a position that I can view it while still maintaining eye contact on the patient. It helps to have a second set of hands-- usually the one's I've seen in EDs come on a rolling cart the the portable BP machines.
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