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/moneybags493 21d ago edited 21d 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….

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u/EBMgoneWILD ED Attending 21d 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 Time for a better argument to push for outdated equipment.

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u/moneybags493 21d ago

My apologies, meant to write VL not DL. I corrected my post now.

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u/EBMgoneWILD ED Attending 21d 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.