Will Video Laryngoscopy become the norm?

[u/Radiant_Alchemist]

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.

[u/Competitive-Young880]

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!!