Video Laryngoscopy

[hogwiley]

We dont use video Laryngoscopes where I work, but in Paramedic school I did a bunch of glyde scope intubations in the OR and found it way easier, it was almost cant miss, although I did see residents miss in the ER with them.

 

[Jason]

We use Intubrite. Have the old manual equipment as well, but when we started using the Video Laryngoscope, we were told to use it first if possible. We started to use the Intubrite last year.

 

[chaz90]

For the people who are using VL, have you made a complete transition, or is it a backup/option to use it instead of DL?

How much training and what kind did you get on them before the switch, and how often is it being used?

We have completely transitioned to using VL with the KingVision as our first line tool for intubation in adults. We are expected to use it unless there is some kind of reason not to based on anatomy, equipment concerns, or a wet airway with anticipated difficulty with VL.

We went through a department wide continuing education session with an overview of VL and specific training with the KingVision prior to it being rolled out. We also had a couple trial units for months in advance that were kept at or units with the highest number of intubations. All staff had the opportunity to rotate through those stations if requested in an attempt to play with the devices and use them on real patients if possible. After the KingVision was chosen for implementation, our FTO supervisor came around to each station with a mannequin and a KingVision to allow every paramedic to try it for as long as they needed and sign us off on proficiency. The difficulties have obviously centered around getting live intubations prior to rolling them out, but every medic has had a chance to use it in the field at this point.

The number of uses obviously varies based on the medic, but I personally seem to intubate ~10 patients/year in the field. Since we've started using VL, I've used the KingVision in 5/7 attempts. On one of the two that I utilized DL another provider had failed twice with the KingVision and I didn't want to mess around with another of the same attempts on a patient that was clearly difficult. On another patient the airway was full of vomit that we had difficulty suctioning effectively and we chose to go straight to a standard Mac 3 blade.

 

[SPGMED]

I used to use the glidescope ranger at one of my previous ground services. I have to say I enjoyed it and found it to be very user friendly. The separate screen was a little less intuitive but gave fantastic resolution. The other plus was the size of the screen compared to the CMAC (the flight service I work for currently uses this. Not a bad laryngoscope at all) was much larger. The overall size may be an issue for some services. It required a lot of reconfiguration to make space in our airway kit for the glidescope.

 

[STXmedic]

Well, just found out our Pentax is useless now. I used our last adult blade last shift, and they apparently aren't making them anymore. On the bright side, hopefully we can get my McGrath now

 

[triemal04]

We have completely transitioned to using VL with the KingVision as our first line tool for intubation in adults. We are expected to use it unless there is some kind of reason not to based on anatomy, equipment concerns, or a wet airway with anticipated difficulty with VL.

We went through a department wide continuing education session with an overview of VL and specific training with the KingVision prior to it being rolled out. We also had a couple trial units for months in advance that were kept at or units with the highest number of intubations. All staff had the opportunity to rotate through those stations if requested in an attempt to play with the devices and use them on real patients if possible. After the KingVision was chosen for implementation, our FTO supervisor came around to each station with a mannequin and a KingVision to allow every paramedic to try it for as long as they needed and sign us off on proficiency. The difficulties have obviously centered around getting live intubations prior to rolling them out, but every medic has had a chance to use it in the field at this point.

The number of uses obviously varies based on the medic, but I personally seem to intubate ~10 patients/year in the field. Since we've started using VL, I've used the KingVision in 5/7 attempts. On one of the two that I utilized DL another provider had failed twice with the KingVision and I didn't want to mess around with another of the same attempts on a patient that was clearly difficult. On another patient the airway was full of vomit that we had difficulty suctioning effectively and we chose to go straight to a standard Mac 3 blade.

I'm curious, are you guys finding any changes in either your overall success rates, or the number of attempts needed to place the tube? Or is it still to early to tell?

With about 10 intubations a year, what's your personal feeling; do you think you'll be able to maintain proficiency with both DL and the King?

 

[chaz90]

I'm curious, are you guys finding any changes in either your overall success rates, or the number of attempts needed to place the tube? Or is it still to early to tell?

With about 10 intubations a year, what's your personal feeling; do you think you'll be able to maintain proficiency with both DL and the King?

I haven't seen any system wide data, so I don't really know how it's looking overall. We did receive an email several months ago from our data analysis guru that our first pass success rate is close to unchanged. He said they expected some changes in success as we rolled out completely new technologies and new techniques, and those expectations have been validated by anecdotal provider reports of additional attempts with the KingVision or DL.

I truly don't know how I'll maintain/achieve full proficiency with both devices. We have the opportunity to go to the OR for intubations as needed, and I wouldn't be surprised if I end up returning to the OR again next year for additional voluntary practice with DL as so many of our field intubations are VL. We aren't able to use the KingVision in our local OR, so our options there are DL or GlideScope.