r/emergencymedicine • u/Radiant_Alchemist • 22d 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.

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u/Aquamans_Dad 22d 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? 

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u/[deleted] 22d ago

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u/makes_nosense 22d 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.

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u/StandAntique 22d 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.

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u/Penlight_Nunchucks ED Attending 22d 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.

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u/Aquamans_Dad 22d 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. 

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u/adoradear 22d 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.

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u/bobhadanaccident Resident 21d 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