Take command of the airway

Now let’s walk through a typical video laryngoscopy (VL) intubation.

 Battle of the Blades: The Death of DL?

Awfully harsh words from the man who wrote the book on emergency airway management. 8 years later, direct laryngoscopy is still widely practiced in Emergency Departments, however in some centers, video laryngoscopy is now the most commonly used device. Is it just a matter of time before direct laryngoscopy is considered as outdated and crude of a device as Ron Walls claimed in his infamous appearance on EMRAP in 2012?

 Hyperangulated Hiccups

Hyperangulated VL is a fantastic weapon in our armament, but comes with its own unique set of challenges compared to DL.. The following tips on hyperangulated video laryngoscopy (VL) are written with use of a GlideScope® hyperangulated blade (e.g. LoPro S3 or S4) in mind, but in principle would also apply to the use of a C-MAC D blade.

 Tips and Troubleshooting for Use of the GlideScope Video Laryngoscope for Emergency Endotracheal Intubation

With the hope of generating confidence in the video laryngoscopy procedure, we have compiled some basic tips that we have found helpful when intubating with the GlideScope. These tips include inserting the blade to the left of midline to improve space allowed for the endotracheal tube itself, backing the scope up a small amount to improve the view, holding the tube close to the connector to improve maneuverability, and withdrawing the tube with your thumb to improve advancement through the cords.

In Defense of Direct Laryngoscopy

We emergency physicians consider ourselves masters of resuscitation. What is the essence of resuscitation? The ABC’s: Airway, Breathing and Circulation. If we want to own resuscitation, we have to own the airway. If that is the case, why would we ever remove from our skill set the technique that has proven itself to be highly reliable and successful ever since its inception in 1943? Is DL dead? No, and emergency physicians need to continue to learn, practice and embrace this essential skill.

Is GlideScope® the Best Way to Intubate?

In my opinion, the GlideScope® is a useful backup tool for intubations that failed with direct laryngoscopy.

Laryngoscopy (GlideScope) Technique

Dr. Rodger White demonstrates a two-handed technique with the GlideScope that he has developed to consistently and safely intubate with constant visualization of the endotracheal tube tip.

The usefulness of endotracheal tube twisting in facilitating tube delivery to glottis opening during GlideScope intubation in infants: randomized trial

GlideScope blade size 0 for patients under 1.5 kg in weight, size 1 for patients between 1.5 kg to 3.6 kg, size 2 for patients between 1.8 kg to 10 kg, and size 2.5 for patients between 10 kg to 28 kg.

Tips and Troubleshooting for Use of the GlideScope Video Laryngoscope for Emergency Endotracheal Intubation

Although there is often ample space for the laryngoscope and ET tube, sometimes, space is limited, especially in those with small mouths. Although it is generally well accepted that a midline approach is important in achieving the optimal laryngeal view [17], situations arise in which a midline approach makes passage of the ET tube into the mouth difficult.

Tips with Glidescope

The common mistake I see when students start to use the video laryngoscope is that they hold the styleted tube in the middle like performing DL. Instead, hold the tube at the very top. When you see the tip of the tube pass the oropharyngeal cavity, you start this slot machine motion to drop the tube to the level almost parallel to the ground. This allows the tip to advance anteriorly towards the vocal cord.

Video Laryngoscopy in the ED: A Review of Devices, Techniques, and Evidence

Simply referring to a device as a video laryngoscope or VL blade, or using brand names such as “C-Mac” or “Glidescope,” can lead to confusion, as these terms encompass multiple different devices with different advantages/disadvantages and accompanying techniques.