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/gottawatchquietones ED Attending 22d 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.

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u/sum_dude44 22d ago

I will reluctantly say VL is superior even in cases of vomiting if you suction. And I learned strictly DL in 2010

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u/Resussy-Bussy 22d 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.

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u/Aviacks 22d 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.