Intubation Style

[MediMike]

Hey folks!

Curious as to who is still doing direct laryngoscopy in the unit vs direct. Since I left being a medic years ago I let my direct skills lapse a fair amount, still get in practice time on manikins while teaching, but pretty much use a hyperangulated Glidescope while in house.

If you're using video, what are you using?

[EMEDPA]

I have not done a direct on a pt in 4 years. I use the glidescope 100% of the time now. I keep my skills up on the flexible fiberoptic as well. I was a medic in the 90s before RSI, so had plenty of opportunity to do DL and nasal then. 

[LT_Oneal_PAC]

Direct only. We have a big shiny new glide scope, but no one bought the rigid stylet. 

[EMEDPA]

1 hour ago, LT_Oneal_PAC said:

Direct only. We have a big shiny new glide scope, but no one bought the rigid stylet. 

You are kidding, right?  you can use the glidescope without the rigid stylet.....

[LT_Oneal_PAC]

23 minutes ago, EMEDPA said:

You are kidding, right?  you can use the glidescope without the rigid stylet.....

I know you can. I mean, I’ve done it, but it wasn’t smooth by any stretch. I haven’t missed a tube since 2011 except for when trying to intubate without a rigid on glide scope. Probably because I always trained with the rigid stylet for the hyperangulated both in anesthesia school and residency. It’s not lack of skill, since I’ve tubed 1500+. Just a lack of practice without the rigid I suppose. So until I get my rigid, I’ll stick with my fastest and most reliable method, and just fiberoptic the c collars. 
 

Only one study was done on the subject and the standard styler took on average 8 seconds longer and failed twice, requiring rigid stylet rescue. If I’m going to go so far as to say “every intubation desires VL” then we might as well say every hyperangulated blade deserves a rigid stylet.

 

personally I would prefer a standard Mac blade VL so that way you can practice both skills every time.

 

 

[EMEDPA]

I have played around with the Cmac at difficult airway courses that can be used direct or VL with the same blade. 

[dmdpac]

We use the CMAC in my department.  I want to like it but no matter how often I use it I feel a disconnect between looking at the monitor and placing the tube.  Oddly enough, I didn't feel that same disconnect when using a Glidescope.  Our anesthesia guys use the Glide Scope but won't let us touch them.  At the same time they won't touch our CMACs.  I've played with a McGrath and like the feel likely due to muscle memory as it's pretty similar to DL.  I've never used the McGrath on a real patient, though.

I don't think I've used DL for an intubation in a few years.

[MediMike]

On 3/27/2021 at 5:40 PM, EMEDPA said:

You are kidding, right?  you can use the glidescope without the rigid stylet.....

Are you regularly using a hyperangulated blade without the stylet?

[EMEDPA]

15 hours ago, MediMike said:

Are you regularly using a hyperangulated blade without the stylet?

Maybe half the time if the stylet is off getting sterilized. Hasn't been a problem. 

[LT_Oneal_PAC]

16 hours ago, EMEDPA said:

Maybe half the time if the stylet is off getting sterilized. Hasn't been a problem. 

Which is why emed is best. I’d rather be lucky than good, unless I can be emedpa good

clarification: not sarcasm

[ohiovolffemtp]

I still prefer DL, usually with a Mac 4.  We have the McGrath and I've used it, but I have way more reps with DL, so it's my go to.  Confession: I'm lousy at video games too.