FriarMedic Posted July 24, 2011 Share 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. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 24, 2011 Moderator Share Posted July 24, 2011 we have an adult and peds glidescope. some of our staff use them 100%. my feeling is that they should be for backup so you don't lose basic skills. the handles are fairly delicate and easy to break so if you only have 1 and it breaks you need to know other methods. one of our docs broke our peds one in a code and it took months to replace. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted July 24, 2011 Moderator Share Posted July 24, 2011 we have an adult and peds glidescope. some of our staff use them 100%. my feeling is that they should be for backup so you don't lose basic skills. the handles are fairly delicate and easy to break so if you only have 1 and it breaks you need to know other methods. one of our docs broke our peds one in a code and it took months to replace. Link to comment Share on other sites More sharing options...
kargiver Posted July 24, 2011 Share Posted July 24, 2011 The Storz C-MAC is far superior in my humble opinion... it is the only system the mimics DL without having to manipulate the stylette during the intubation process. At two of my jobs we use the glidescope and the other we use the Storz. Both work fine but at least for me, the Glidescope realistically is a 2-man intubation process (not including the bagging of the patient) whereas the C-MAC is a 1-man setup... But like all things, its a matter of preference. And about 1/5 intubations I do I do DL to maintain my DL skills... Cameras can break or be unavailable.... G Link to comment Share on other sites More sharing options...
kargiver Posted July 24, 2011 Share Posted July 24, 2011 The Storz C-MAC is far superior in my humble opinion... it is the only system the mimics DL without having to manipulate the stylette during the intubation process. At two of my jobs we use the glidescope and the other we use the Storz. Both work fine but at least for me, the Glidescope realistically is a 2-man intubation process (not including the bagging of the patient) whereas the C-MAC is a 1-man setup... But like all things, its a matter of preference. And about 1/5 intubations I do I do DL to maintain my DL skills... Cameras can break or be unavailable.... G Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 26, 2011 Moderator Share Posted July 26, 2011 For airways, I prefer to always start with DL with the Glidescope as a backup (now that it's available at all our facilities). During my residency I had an equal # of intubations with DL/Glidescope/Lightwand during my anesthesia rotation....and maybe it's just that I'm more of an old-school kinda guy, but I like being able to nail it with the DL. My last intubation was an obese asthmatic whom I intubated with DL- and I attributed the success far more to the positioning of her airway rather than my skills with the blade. Proper "ear-to-sternal notch" positioning truly does work, whether DL or Glidescope being your poison... Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted July 26, 2011 Moderator Share Posted July 26, 2011 For airways, I prefer to always start with DL with the Glidescope as a backup (now that it's available at all our facilities). During my residency I had an equal # of intubations with DL/Glidescope/Lightwand during my anesthesia rotation....and maybe it's just that I'm more of an old-school kinda guy, but I like being able to nail it with the DL. My last intubation was an obese asthmatic whom I intubated with DL- and I attributed the success far more to the positioning of her airway rather than my skills with the blade. Proper "ear-to-sternal notch" positioning truly does work, whether DL or Glidescope being your poison... Link to comment Share on other sites More sharing options...
Lewitt Posted September 24, 2011 Share Posted September 24, 2011 One of my CCT medic partners made this donut that he carried with him to slide under the patients head for proper elevation. I agree its a critical piece of the pie! Glidescopes are awesome and alot of the community hospitals around here were getting the with DHS grant money. As much as I hate to say it, I agree that DL will go the way of DPL and lidocaine in the near future... Lewitt Just as an aside, the BURP manuver has been taken out of my airway managment on the advice of Dr. Ron Walls who teaches the Difficult Airway course at theairwaysite.com Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted October 4, 2011 Share Posted October 4, 2011 Lewitt, I'm curious as to why the BURP maneuver has been taken out of your airway management. Dr. Steve Carleton, who developed it, is a big influence locally. Thanks. Link to comment Share on other sites More sharing options...
medic25 Posted October 4, 2011 Author Share Posted October 4, 2011 I took the Ron Walls Airway Course this past weekend, and they were still teaching BURP. The have taken out the Sellick's maneuver, and the BURP is being taught as a 2-person technique (operator manipulates the trachea, then once they've got a view they like have someone else hold it in place) Link to comment Share on other sites More sharing options...
cbero Posted October 13, 2011 Share Posted October 13, 2011 *New PA Student (just accepted to a program), but with 5 years as a RT I thought I could justify chiming in. We started using the Glidescope on 100% of our intubations in the ED about 2 years ago. We also have the disposable blades model, which can make for quick turn-arounds in multiple incidents. JWK is right on about the stylet, we have a specific one that has to stay with the scope. In the ICU we have another unit that is used, but more times than not, intubation is done with the bronchoscope. I'm not sure why a 2nd person would be needed though. As an RT I usually visually confirm with the intubating practitioner, pull their stylet, and inflate the cuff for them all while bagging. I agree that it is important to keep up basic skills, but I can see these eventually becoming standard in ED care. Before laws changed in AZ, I can remember many patients coming in with teeth knocked out and multiple abrasions from difficult field intubations. If something can be done (a) faster, (b) with better results, and © with less potential for trauma, why not do it 100% of the time? I don't see the argument for tucking it in a corner, having 3 people fail at a standard intubation, and then breaking it out. It seems like an expensive thing to have around to not use. Am I off base? Link to comment Share on other sites More sharing options...
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