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Medical Cases Podcast

Medical Cases Podcast is a medical variety show whose target audience includes Internal Medicine and Emergency Medicine residents, medical students and foreign medical graduates. Podcasts will be 1 of 4 types: knowledge pearls (KP), clinical pearls (CP), board review (BR) and cases.
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Medical Cases Podcast - EM/IM/Critical Care

Oct 28, 2016

 

Each video larnygoscope model has its subtle quirks and troubleshooting techniques. The following techniques are useful when intubating with the Glidescope AVL:

  1. Consider a deliberately restricted laryngeal view to aid in tube placement. Do this by withdrawing the glidescope slightly. Verathon recommends that the glottic apperature should occupy the "upper 1/3 of the screen".
  2. Use the 1-4 step approach as per the Verathon official recommendations: see Verathon Glidescope Technique Video 
    1. Look at the mouth to introduce glidescope midline.
    2. Look at the screen to "obtain the best glottic view".
    3. Look at the mouth to introduce the ET tube.
    4. Look at the screen to pass the tube through the chords.
  3. Look at the patients mouth when initially inserting the ET tube into the mouth- not at the screen.
  4. Practice using VL!
  5. Try shifting the entire laryngoscope to the left to allow more room for insertion of the ET tube into the mouth. 
  6. When trying to pass the ET tube through the chords, hold the ET tube by the end furthest from the patients mouth. This will give you a longer lever arm. There is also a small grip on the Glidescope rigid stylet for this purpose; this grip can also be used to 'pop the stylet' when needed. Simply flick your thumb up. 
  7. Consider withdrawing the stylet 3-5 cm if having difficulty passing the tube through the chords. This will straighten the tip of the tube allowing it to follow the natural curve of the trachea. 

 

For tip #3 I mention that you should be looking at the mouth while introducing the ET tube. During this, it is easier to slide the ET tube underneath the right sided flange that the glidescope has. This concept is illustrated in the Mgrath X blade below where this region is labeled as the "ET Contact Zone".

 Mgrath Xblade with "ET Contact Zone"

 

 

Thanks to all of our listeners around the world! New Zealand, Pakistan, India, Nepal, UK, Canada and Australia!

 

 

References: 

Bacon, E. R., Phelan, M. P., & Doyle, D. J. (2015). Tips and Troubleshooting for use of the GlideScope video Laryngoscope for emergency Endotracheal Intubation. The American Journal of Emergency Medicine, 33(9), 1273–1277. doi:10.1016/j.ajem.2015.05.003

GlideScope® Video Laryngoscopes Channel, ©2012 Verathon Inc. 0900-4018-00-86, Retrieved October 28, 2016, from https://www.youtube.com/watch?v=7jb2tbqQ6VQ

Carlson, J. N., & Brown, C. A. (2014). Does the use of video Laryngoscopy improve Intubation outcomes? Annals of Emergency Medicine, 64(2), 165–166. doi:10.1016/j.annemergmed.2014.01.032

Duggan, L. V., & Brindley, P. G. (2016). Deliberately restricted laryngeal view with GlideScope® video laryngoscope: Ramifications for airway research and teaching. Can J Anesth/J Can Anesth Canadian Journal of Anesthesia/Journal Canadien D'anesthésie, 63(9), 1102-1102. doi:10.1007/s12630-016-0681-3

 

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