r/emergencymedicine • u/Radiant_Alchemist • 21d ago
Advice Will Video Laryngoscopy become the norm?
I love VL. They make standard laryngoscopes look brutal. They're less traumatizing, they give a better view, they have a better first-pass success. Sure you need to learn direct laryngoscopy but let's say in 5 years from now will they be used as routine in OR and ER intubations? Or will they be saved for hard cases?
I've been told that the equipment tends to suck and that we won't have VL as available as in the current department that I'm working so I should stick to Macintosh and McCoy.
139
u/Aquamans_Dad 21d ago
I think it has been the norm for at least ten years.
Why subject patients in an emergency situation to an inferior method when a superior method is readily available?
30
u/Aquamans_Dad 21d ago
And if it’s not readily available, why not?
According to Google a disposable I-view is $100, and permanent ones with cheap disposible blades start at $600.
Have used the I-view for codes on the floor, they’re not bad. Prefer my Glidescope in the ED but the I-view is much preferable to direct laryngoscopy and I’m old enough to have been around when that was still the norm.
9
21d ago
[deleted]
47
u/makes_nosense 21d ago
You should absolutely be able to DL someone. Technology does and will fail. Or, what happens when one of your partners forgets to put the screen on the charger and it’s dead when you go to use it? VL should always be first line in my opinion. However, you should be proficient in all types of airway management.
12
u/StandAntique 21d ago
OP, this is the exact right answer and has been for at least a decade in my experience. VL should be your first line. Yet, you have to know how to DL for the reasons mentioned above. Thus why med school rotations/residency is so important for learning both.
10
u/Penlight_Nunchucks ED Attending 21d ago
Why does your department only have one VL and tolerate the possibility for device failure? We are a small rural department and have 3 VLs in the department. A backup to the backup.
4
u/Aquamans_Dad 20d ago
Practise DL during an anesthesia rotation with stable elective patients. If you’re intubating in the ED it is by definition an emergency. Don’t use an inferior method on an unstable patient in an emergency for educational purposes.
2
u/adoradear 20d ago
DL is important to know. Occ you’ve got a bloody/messy airway and video will fail you. Both are important. Most of the time VL is superior, but not always.
1
u/bobhadanaccident Resident 19d ago
I like to practice DL with a MAC 4 or whatever attached to the glidescope. You can try direct for one pass and then tube with VL if you don’t get it quickly. Dope part about using MAC blades instead of hyperangulated is you already have a backup if your machine shits the bed
37
u/gottawatchquietones ED Attending 21d ago
DL is really only superior in instances of massive vomiting that keeps getting on the camera. This is rare - I've only had it happen once in several years. But still, it would suck to fail to intubate because of this. That's why I like the Mac blades with a camera on them - I can use them for VL 99.9% of the time, but fall back to DL with a blade geometry that allows it on the rare cases it's needed. Best of both worlds.
20
u/sum_dude44 21d ago
I will reluctantly say VL is superior even in cases of vomiting if you suction. And I learned strictly DL in 2010
6
u/Resussy-Bussy 21d ago
Especially if you have a standard geometry VL. Can instantly convert to DL if video view is shit. But even in contaminated airways the video is almost more helpful for me than not especially with suctioning. Lead with suction with VL behind, Can suction much more precisely with video (and if you have a decanto suction cath even better) compared to just eye balling it or blind suctioning.
2
u/Aviacks 20d ago
I’ve always aggressively lead with suction and have thus far never had issues with vomit filled train wreck airways. The only time I had an issue was with a self inflicted GSW to the head that had fragmentation go through his airway and was actively spurting blood for multiple places in this airway. But DL didn’t save me there either.
That being said I’d love access to a CMAC or McGrath again. McGrath you have disposable covers that can do both which is nice. Just swap to the x blade if you need the hyperangulated, it’s fast and cheaper than a glidescope blade.
1
u/PerrinAyybara 911 Paramedic - CQI Narc 17d ago
Even more so if you use a large diameter suction like a "Ducanto" or "Big Stick". Otherwise you can take a sz8 ETT pull off the BVM adapter, flip it around and attach to suction.
Massive difference for vomiting airways compared to a yaunker.
5
u/FightClubLeader ED Resident 20d ago
I recently had to DL bc the guy was coding and we couldn’t find the glidescope and get it in position quick enough. He wasn’t coming up with bagging and had aspirated. It was a shit show, but I was glad I learned DL well.
2
u/ProtectionPolitics4 20d ago
Just make sure you're suctioning as you go. Or standard geometry blade.
I've had a couple horrific vomiting cases and VL was still immediately superior and worked great.
28
u/Zentensivism EM/CCM 21d ago
In 🇺🇸👨⚖️💸 you argue that a superior modality was not utilized on your first attempt when a case goes poorly?
11
u/Nearby_Maize_913 ED Attending 21d ago
same argument I use against people doing SC CVLs
3
u/Crunchygranolabro ED Attending 21d ago
Ultrasound guided SC? Although I’ve only done about 10 total.
5
3
u/Aviacks 20d ago
Just something to consider, the mortality rate for a CLABSI is higher than an iatrogenic pneumo. You can decompress a small pneumo in the worst case pretty easily. There’s no quick fix when they become septic from their IJ.
If you’re taking the time for a lower IJ insertion like here:
https://youtu.be/egSzUO2L1bE?si=MPcnzf5cb3BPhF3L
I’d say there’s less of an argument for subclavian. But keeping the dressing intact and clean on an IJ is very difficult on a lot of patients. Vs subclavian being much easier to keep intact and clean and do a sterile dressing change. There’s the argument that a blind subclavian will be “best” if you’re arguing CLABSI prevention but I think that’s more easily fixed with proper equipment and insertion technique to avoid contamination with the gel and probe.
5
u/writersblock1391 ED Attending 20d ago
I mean the superior modality is the one you're more facile with.
I'm probably an outlier here in that I'm relatively young (graduated in 2020) and still DL for >80% of my airways. I legitimately am faster with DL and can more easily troubleshoot a difficult airway with a standard geometry blade most of the time.
The backup to digital will always be something analogue. In a world where we have experienced normal saline shortages, benzo shortages, PPE shortages and other supply issues which would be considered austere in most contexts, the presumption that you will always have access to VL and the associated equipment seems short-sighted to me.
3
u/moose_md ED Attending 20d ago
I’m also young, and I always DL first, unless I anticipate a difficult airway. I have video and a bougie on hand as backup with a low threshold to use them
0
u/ProtectionPolitics4 20d ago
It's statistically not possible to even have that many difficult airways with VL. Almost every airway is very easy as long as you've done the right pre-intubation stuff, if you're using VL.
DL is where you actually need skills to troubleshoot. But why? It just adds patient risk. Just so one day, just maybe one day, you can be more proficient when the power goes out. Chances are that day never comes. And even if it does, the cumulative risk of patients being exposed to DL over the years is far higher.
4
u/writersblock1391 ED Attending 20d ago
DL is where you actually need skills to troubleshoot. But why? It just adds patient risk. Just so one day, just maybe one day, you can be more proficient when the power goes out. Chances are that day never comes. And even if it does, the cumulative risk of patients being exposed to DL over the years is far higher.
Not to put on a tinfoil hat but a year ago we were rationing normal saline because of national shortages. 5 years ago we were rationing PPE. Right now we're rationing ativan. Assuming that you will always have optimal working conditions and access to the most advanced equipment is pretty short sighted.
18
u/Competitive-Young880 21d ago
When I am in the er, my first try is always vl with bougie. I keep my dl skills sharp during my icu time. Er is not the place to show everyone that you can intubate an obese hypoxic septic pt using just your feet and a tongue depressor.
16
u/sum_dude44 21d ago
was this written in 2012?
3
u/doopdeepdoopdoopdeep 20d ago
I was gonna to say, I became an ED RN in 2016, later transferred to ICU and I don’t think I’ve ever seen an ED or ICU doctor do intubate with anything but VL.
I didn’t know until I started working with anesthesia in IR that anyone used DL anymore. 😂
5
u/turn-to-ashes RN - CVT ICU 20d ago
meanwhile we're bagging a pt in PEA in ICU and need an airway, anesthesia gets there and starts farting around looking for a VL because we only have DL in our airway box. the PA goes "do you really think now is the best time to be looking for a glidescope?" and one-shots it.
7
u/ProtectionPolitics4 20d ago
Maybe stock the area better? Sounds like a patient safety issue.
0
u/turn-to-ashes RN - CVT ICU 19d ago
we don't stock them. the OR next door does. he was getting in a bunny suit to go look in there. the PA got the airway just fine with a DL that was already available.
12
u/Competitive-Young880 21d ago
There are two different scenarios. Either you’re talking emergency dept intubations (which I will discuss because this is EM sub) or OR elective intubations. In the ER the evidence is clear, vl is better. If you’re working in a place without it in a first world country throw a fit. For those saying people need to be proficient in both, I’m not sure if I truly believe it, but I do teach my residents that way. I tell the residents they need to know both even though I don’t fully buy it. That said, no harm in being more knowledgeable and more tools in toolbox. When supervising an intubation where I’m having resident do dl/im gonna do dl, I only do it with a video scope. Dont look at the screen. Try to dl. If you can’t get a good enough view/ have trouble, look at the screen. I pretty much never myself/let residents put a non video blade in a pts mouth. I see no benefit to it. Go ahead try dl, but make sure you have the video available in 1sec if you’re struggling. Recently I was called to a crumping pt to throw in a ric and a triple lumen, as I’m putting them in, another attending is watching a jr resident do a dl. Resident can’t get a good view. She asks for cricoid pressure, still no view. At this point it’s been about 2.5min. Pt is desatting. 20 seconds to get video scope in her hand and screen on. Now ok view but trouble passing the tube. Then her staff pushes her to the side, and gets good view and tube. I understand wanting to keep your skills sharp and forgoing the better first pass rate of vl to keep dl skillls. But you only get ONE try with that. If dl isn’t working you go straight to VL with bougie. Never should anyone taking so long to get to the combo that has the best first pass success rate. It is not failing or a lack of skill to use a vl or bougie. It’s what’s best for the pt!!
10
u/Final_Reception_5129 ED Attending 21d ago
I have no issues with VL. I DO have issues with trainees never learning important things that we HAD to know with DL (patient positioning, how to use a bougie, cric pressure, etc). These are skills that you need if you do intubations on 400lb COPD patients or 4 day old premies. EM docs need ALL THE SKILLS, not less.
3
u/Alarming_Middle_721 21d ago
Agree wholeheartedly. VL allows a high success rate without optimization- easy to get good at intubating with bad technique. I use VL almost exclusively and with a hyperangulated blade most of the time- but I learned appropriate positioning and optimization by learning with DL or standard geometry VL with the screen flipped to my attending in training. That has proven invaluable to me and I’m sure to my patients.
1
u/ProtectionPolitics4 20d ago
It's called doing hundreds of reps in the sim lab and 100 tubes in the OR. There is zero doubt you get the necessary DL skills doing that.
6
u/Soulja_Boy_Yellen ED Attending 21d ago edited 21d ago
If you’re saving a certain type of intubation for hard cases you’re going to suck at them and it won’t be useful. We all talk about busting out fiber optic and that’s great but we’ll probably still get our go to approach quicker and with a higher first pass success rate.
Hyperangulated is fine and will get you 98% of tubes but if that’s all you use you’re going to have a few hairy tubes so I avoid.
I think that VL standard geometry blades (C-mac) are great and not using them if able has become close to a deviation from standard of care. In my residency a lot of the faculty would turn the screen away from me so I had to do direct but they could watch and if needed they’d move the screen back. That I think helps if the wire disconnects from the video tower or the battery dies on the video screen (I’ve had that happen before)
4
5
u/zimmer199 21d ago
I’ve heard some of my anesthesia colleagues lamenting that their trainees are going for VL on all of their cases, and have had more than a few say DL is going to disappear. And all the naysayers keep bringing up soiled airways and massive hematemesis, but with the SALAD technique and wiping the camera on the patients gown and reinserting two seconds later I’ve never had an issue with camera blockage. I say this as someone who enjoys DL, but yeah, the writing in the wall says VL will become standard in the field, ER, and OR.
3
u/bananosecond 21d ago
I think it's bizarre that anesthesiology residents are apparently not being trained appropriately with DL. My group hired an anesthesiologist who was surprised that we didn't have glidescopes in every room and said he had to brush up on his DL skills. To a degree, I understand the allure of VL for EM and critical care since they don't as many opportunities in elective situations to practice. The studies showing superiority of VL are usually in learner or non anesthesiologist practitioners, but as I, and probably you and other DL-proficient EM docs know, essentially everybody can be intubated with DL.
6
u/bellsie24 21d ago
I think it's a great tool that has an unbelievable amount of benefits for providers and patients.
I also think it has limitations that tend to get glazed over by some people championing "VL and bougie are the only option for great first pass success!!!!".
And I think some of these limitations are especially problematic in emergency medicine, namely how frequently the cameras can get obstructed by fluid or secretions, given our non-NPO patient population, difficulty in optimization, trauma, etc.
I also find the devices that require a completely different mechanical use/insertion (like the AirTraq) to be difficult as a backup/rescue device due to the fact you must use a different technique than you're already used to (and it's not as though we're anesthesia intubating half a dozen people a day with the ability to regularly rotate through devices to keep ourselves proficient).
0
21d ago
[deleted]
3
u/bellsie24 21d ago
I have nothing other than anecdotes with no data, but:
I'm unbelievably curious to see how the next decade plays out in terms of VL versus disposable fiberoptic scope intubations in the OR. A few of the anes/CC docs at my shop (who obviously do a lot of bronchs while on ICU coverage) are in love with fiber scopes and will do that before VL on any anticipated complicated airway.
6
u/Crunchygranolabro ED Attending 21d ago
VL was preferred for first pass during my residency, and continues to be what most everyone (including the crusty old guys) reach for as our first pass in the community. So in short: I feel like VL is already the norm.
In residency the preference was that we used the video mac to VL, while the attending watched the screen. In practice, plastic doesn’t have the same power that metal does when it comes to lifting tissue, so it made it a bit harder.
As more people are obese with fat necks and extra jowls…hyperangulated is just too effective.
2
u/MarginalLlama Paramedic 21d ago
Respectfully, how much tissue are we ortho-broing with a VL? Even in short-neck obese patients, positioning the VL well and a little BURP has worked well without needing to do any significant tissue displacement with the VL blade. I guess I'm just curious if there is something I'm missing or could learn?
2
u/Crunchygranolabro ED Attending 21d ago
Video gets a great view on the screen. And those of us of the younger video game generations are pretty facile with hand-screen coordination.
You hit the nail on the head, that it’s about technique and preparation or lack thereof.
Specifically using a plastic mac3-4 blade to get a direct view can be less forgiving of sloppy technique. You need good positioning, really good tongue sweep, etc. Whereas a metal blade provides an easier tongue sweep and with a bit of muscle can lift the laryngeal anatomy, along with the whole head to make up for bad positioning.
My general approach is to use a video mac 3-4 for a DL look, plus/minus a bougie more to keep in practice and reinforce good technique for most “simple” airways, knowing that if needed I can always look up at the screen. I use the hyperangulated blade for the physiologically scary, or anatomically difficult tubes where I want to be as smooth and fast as possible, because that’s the device I’m most comfortable with.
1
u/MarginalLlama Paramedic 20d ago
Thank you for the clarification and detail!
The plastic vs metal piece makes sense to me now, and I'll have to consider using the video mac blades for a direct look in the future.
3
2
u/Ok-Raisin-6161 21d ago
My shop has MAC VL in addition to glidescope (hyperangulated). It’s nice, because you can try either way with the same attempt.
I think COVID pushed a lot of places to VL because it reduced exposure. So now it’s more widely available. I know in training, we were supposed to exclusively use VL for most intubations for a year or 2 because of the risks. (Most being basically all emergent intubations, elective/pre-op intubations were still often done direct.)
2
u/bpos95 Paramedic 21d ago
It has become such the norm that it has made its way into being the standard in the EMS world, and we never get anything! There are still those that say they prefer DL over VL, but you can't ignore the data showing our first attempt success rate significantly improved after VL implementation. Granted, it is still a tool that needs to be trained on with consistency for better patient outcomes and less Airway trauma.
1
u/thegreatshakes Primary Care Paramedic 21d ago
Reading these comments made me realize my service is getting behind. We still have DL and no plans to switch over to VL.
2
u/Chir0nex ED Attending 21d ago
I guess it depends on where you work by VL is widely prevalent in US ERs.
DL is still a valuable skill. I honestly am worried that my residents are not developing good intubation skills because VL makes it so much easier. Things like proper positioning and using adjuncts like bougies are just far less common with video. It's gotten to the point that on non-trauma intubations I push senior residents to do DL while we have video standing by if it becomes a more difficult airway.
2
u/gamerEMdoc 20d ago
Its the norm now. Older literature showed similar first past success rates with VL versus DL but VL was more time-consuming. But as time went on and more trainees gravitated towards VL and got less experience with DL, the literature has now shifted and shows a significantly better first pass success with VL compared to DL.
2
u/moneybags493 20d ago edited 19d ago
Anesthesiologist here- VL absolutely increases first attempt success rate for most airways, and should be the go to method for any airway that you anticipate will be challenging or is time critical. However, i worry that the direct laryngoscopy skillset is being lost by the next generation and it’s a critical skill for certain situations like bloody/vomit filled airways. Also, technology can fail and “my glidescope screen died, i don’t know how to DL, and was unable to mask ventilate the patient” probably won’t stand up too well in court….
1
u/EBMgoneWILD ED Attending 19d ago
DL does what? Is there like, a study you can produce that shows this superiority?
Also, the "equipment failure" argument has existed since the OG glidscopes in the 00s. Time for a better argument to push for outdated equipment.
2
u/moneybags493 19d ago
My apologies, meant to write VL not DL. I corrected my post now.
2
u/EBMgoneWILD ED Attending 19d ago
That makes me feel better.
But yeah, most VL are normal geometry now, and most people teach their trainees to use it as DL first, then use the screen as needed.
I can say with 100% certainty that I've had the batteries fail in crappy metal DLs way more than I've had VL fail.
Only VL issue I was around for was a CMAC not fitting between a LUCAS device and the oropharynx. So they switch to McGrath, but it was a head scratcher for a moment, as they were on a sidewalk at the time.
5
u/skazki354 EM-CCM (PGY5) 21d ago
I don’t think VL is yet considered standard of care, but it probably will be in the next 5-10 years. I’d say unofficially it is standard of care, but it isn’t available everywhere. The studies universally show better first pass success. Some of them don’t show any difference in adverse outcomes, but with patients getting baseline sicker every year, first pass success is more important.
In residency, 85-90% of my intubations were DL. Now almost 100% are VL (the rare exception is equipment failure or unavailability).
3
u/lunaincc 21d ago
Man, is pgy 10 really that old? lol. When I was training. It was pretty much seen as weakness if you went VL on first attempt. For the reason that are pretty much worthless in hematemesis or just vomiting in general. In the OR, I can see it as the go to as it is, for the most part, is a controlled environment.
I can remember the last time I used VL, except for a large obese man with no neck in respiratory failure and very little reserve. I do use it from time to time in certain situations and if no reason other than to keep up proficiency.
In my experience, most of the easy VLs ive done would have been just as easy with DL. If I do a DL and am having difficulty, I have become very skilled with a blind bougie.
Just like any other procedure……..results are based on the proficiency of whoever is performing it. I’m a huge advocate of being skilled in multiple modalities. If the only tool you have is hammer, every problem is a nail.
2
u/ProtectionPolitics4 20d ago
I've had a couple awful vomiting cases and VL worked without any issues. Know how to suction simultaneously and that solves your problem.
1
u/lunaincc 20d ago
It’s not problem at all. I just grab a Mac and it’s done. lol. It can def be done. I’ve done VL with suction. At that point It’s just easier and faster for me to do DL. YMMV. I’m all about playing to your strengths. If that’s your go to, have at it. No hate here. 👍
4
u/N64GoldeneyeN64 21d ago
Id love to say VL has never failed me
But its next to useless with vomit/bloody airways. Its useless without a specific stylet if you have a hyperangulated blade. Sure a C-Mac can do both but if you dont know how to do DL, youre still screwed.
And, if you work at shops with less resources that rarely see intubations done, you could be working with something that doesnt work and you wont know until it doesnt turn on.
I think there will be a push going forward for VL only but it will be at the detriment of patients if you arent trained both ways
7
u/Hippo-Crates ED Attending 21d ago
Even in very bloody or vomit airways if you lead with suction and stick it in the goose it goes fine the vast majority of the time. Video should be the standard
8
u/Resuscit8e 21d ago
Yep. This was studied as well. VL > DL for soiled airways. Just don't shove it into the fluids and mess up your camera view.
-3
u/N64GoldeneyeN64 21d ago
Or, you can do DL and not worry that a small piece of carrot that gets stuck on your camera will prevent you from getting the airway
2
u/Hippo-Crates ED Attending 20d ago
Errr sounds like a skill issue tbh
-1
u/N64GoldeneyeN64 20d ago
As in you dont know how to use a DL blade
2
u/Hippo-Crates ED Attending 20d ago
lol. Maybe. Sounds like you can’t use a VL blade though
1
u/N64GoldeneyeN64 20d ago
I usually use VL. I just dont worry if something goes wrong like suction getting occluded by food or clots
2
u/sum_dude44 21d ago
I'm old school DL, & once you suction correctly, VL still better IMO
That said, I can still use DL 4 Mac or Miller w/ bougie in nightmare scenario
2
u/AgtHoliday ED Attending 21d ago
I get that VL is more likely to be successful, and faster. But I’ve seen video fail for lots of reasons - soiled airway, technology failure at the critical moment. So DL is supposed to be your backup when the airway is difficult or the tech breaks or isn’t available.
I learned on DL and there’s way more technique to it. I think you’re setting yourself up for some terrifying situations when you say that the method that’s a lot more difficult, that you never really learned how to do well, and that you never practice because it would be a violation of standard of care to do so, is your backup plan for when the SHTF.
1
u/ProtectionPolitics4 20d ago
You can have multiple VL modalities. So power truly going out should be the only excuse.
1
u/Imn0ak ED Resident 21d ago
In my country there's 2-3 in the only tertiary ER in the country, 4 large screen mobile ones for 10 ORs in house along with handheld VL in most of the ORs. I haven't seen a DL intubation for a while except it being for training purposes during a controlled situation in the OR.
1
1
1
u/GamingDocEM ED Attending 21d ago
It is the norm. There is no reason to be using DL for first pass success if VL is available and functioning properly.
1
u/bmbreath 21d ago
What device do you people use?
I think VL had a great use potential, but have yet to use a portable blade that is smaller than a regular direct look blade. So when we have a tiny person, the VL can be a bit difficult to use.
1
1
u/SillySafetyGirl 21d ago
It’s been the norm everywhere I’ve worked the past ten years pretty much. Prehospital some places still sticks to a twisted ego of DL, but the good services enforce VL as the best practice standard.
1
1
u/Eldorren ED Attending 21d ago
It's become very much the norm at least in my area. That being said, I'm an old timer and so I DL almost 100% of the time but I think I'm the only one in my group that doesn't use VL routinely.
1
1
u/Muted_Evidence7926 21d ago
Frankly, both are a necessary (and important mandatory) skill. Had a glide scope battery failure into an RSI. Yes, before you ask, I personally tested it before but it went out after we used rocuronium. After a brief underwear changing moment, we used a manual blade and were ok.
1
u/DadBods96 20d ago
The paradigm I was trained under is that Video Laryngoscopy is considered Standard of Care if available.
When will it matter? Only under a circumstance where a patient had a poor outcome such as coding from prolonged hypoxemia due to a difficult intubation, or anoxic brain injury. If you get sued, and you documented that you attempted direct laryngoscopy first, you’re SOL because you didn’t adhere to standard of care. The expert witness for the plaintiff will argue that you had a modality available with a higher first-pass success rate and lower blade-to-tube time and chose not to utilize it, and led to the patient’s outcome. Will it be true? Probably not. Will the jury care that you were in a difficult airway situation and the modality that saves 10 seconds wasn’t gonna matter? Definitely not.
Which is why every department should stock the Mac blade attachments for the Glidescope rather than just the hyperangulated blades.
1
u/D15c0untMD 20d ago
I have seen few cases done without VL for a while now. Where did you hear that McGrath is bad equipment?
1
u/medicritter 20d ago
I want to make a very important differentiation regarding those who are saying VL increases first pass rates & those who dont step away from DL can "expect a message from so and so" ...every single study has shown that VL increases first pass rates on those who trained with VL and the same findings were attributed to those who trained on DL ...all of those studies essentially stated thay first pass rates were better on which ever technique you were trained on. Im the perfect example tbh. I was trained on DL. Did DL for the first 7 years as a paramedic because we legit did not have any VL on the ambulance. Then, I was introduced to VL and wasn't the biggest fan. Stayed DL for the next 5 years. I then became a critical care PA, and VL was forced down my throat. Immediately after training, I went back to DL because that's what I know. People are always shocked at how quickly I tube with DL. It takes me longer to Intubate with VL than DL 9 times out of 10. Are there situations i dont do DL? Absolutely. Sometimes i dont do VL either and i go straight to fiberoptic! Point is, dont immediately knock people who stick to DL. Its what they know best and one increases THEIR first pass success rates
1
1
1
u/JadedSociopath ED Attending 20d ago
It already is the norm in ED and ICU in my part of the world, and has been so for over a decade. Using a traditional laryngoscope would be considered reckless for an RSI here.
Where do you work that DL is still a thing outside of the operating theatre?
1
u/Ragnar_Danneskj0ld 20d ago
Paramedic, not a doctor, but I haven't used DL since school. I have no idea how any system or hospital could justify not having VL readily available.
1
u/Movinmeat ED Attending 20d ago
You should absolutely know how to do DL but … VL has been the preferred and standard approach in the US for 10-15 years and anyone who says otherwise is just plain wrong
1
1
u/EBMgoneWILD ED Attending 20d ago
If only there were things like studies that measured outcomes and showed DL was inferior.
Oh wait.
Also, it's 2025.
I use VL in paddocks in rural Australia. You can use it in your hospital. I promise.
1
u/passwordistako Resident 20d ago
Already the norm in 4 different services operating theatres I’ve worked in.
1
1
u/shinbo1428 20d ago
The only scenario where direct laryngoscopy could be better for me is when a patient is actively bleeding inside his airway and impairing the camera view.
It just feels more comfortable for me to do suction when. Am not looking at a screen
Not sure what everyone’s opinion is regarding that
1
u/jwatts21 20d ago
I work EMS and ER. Have VL for both. Have not needed DL for 4ish years and haven’t missed a tube in that time frame either. I still practice DL on the dummies just in case but have not needed it on a real patient in the time I have had access to VL.
Greatly improved outcomes, and the equipment does in fact, not suck.
1
u/DocEmily Med Student 19d ago
We just did our first intubation lab. Seeing how I and every other student did, I’ll take the VL thank you. I like my teeth.
1
u/rainbowtiara15 19d ago
I’ve been out for five years, I’ve Video laryngoscopy on every patient except maybe 1-2 peds cases
280
u/AlanDrakula ED Attending 21d ago
Its been normal for a minute