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Five Steps to Correct Use of VL Equipment

EMS Airway Clinic author and airway expert Graham E. Snyder, MD FACEP, offers us the following five steps to correctly using video laryngoscopy for successful intubations.

Step 1: Know your equipment.

Step 2: Assemble the equipment correctly.

Step 3: Don’t look in the mouth.

Step 4: Use the steel stylet that comes with the Glidecope.

Step 5: Don’t Get too close to the Cords.

Read “See Cords Around Corners” for more from Dr. Snyder.

One comment

  1. Great article by Dr. Graham Snyder and top 5 by Jennifer Berry!

    We just finished a research study with field providers where they could choose Glidescope (GS) versus Direct Laryngoscopy. We have 120 paramedics and outfitted 11 ambulances with GS. Training was lecture, manikin practice and 20 did two intubation in the OR.Our overall success was mid 90%.

    Here are some points we learned to augment the top 5:

    1. Positioning – sniffing position. Make sure the external ear canal is on the same plane with the sternum.

    2. Put the GS in the mouth and put the ET tube (with GS stylet) next to it. (By doing this, you never have to look back at the mouth!)

    3. Advance the GS to get a view of the glottic opening. When you do, lift up on the GS to center the image (top to bottom and right to left) on the video screen.

    4. Avoid “overzoom” If you advance the GS too far (as if it were a Mac blade) you’ll get a very close up view of the cords. Looks great! The problem: you may not be able to insert the ETT through the cords. The reason: you’re looking around the corner and with that much overzoom the stylet can’t curve as far as the airway is located. The solution: back up 1/2 – 1 inch and lift. This should center the image and create conditions for you to succeed.

    5. Pop the stylet to advance the ETT. We liken it to an IV catheter and needle set up. After popping the ETT, advance the ETT off the stylet like an IV catheter off a needle. To remove the stylet, you (or a partner) can rotate it toward the feet to remove. The rigid curve of the GS stylet will rotate out easily when directed toward the feet.

    Hope these help! Here’s a link to a couple of our abstracts:

    http://www.jems.com/article/training/prehospital-care-research-forum-presents-0

    http://circ.ahajournals.org/cgi/content/meeting_abstract/124/21_MeetingAbstracts/A33?sid=f07d47e1-968e-49c0-92d7-2403021ca4eb

    Happy intubating!

    Kevin Seaman

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