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/Zentensivism EM/CCM 22d ago

In 🇺🇸👨‍⚖️💸 you argue that a superior modality was not utilized on your first attempt when a case goes poorly?

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u/Nearby_Maize_913 ED Attending 22d ago

same argument I use against people doing SC CVLs

3

u/Aviacks 22d 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.