Follow Up - Video Scopes

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No me gusta!

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brendan c. -

any tips for the "teasing it in" for the glidescope. I have found that no stylet helps but i'd love to hear your thoughts
PS we have glidescopes and use them primarily for predicted difficult airways. Just yesterday went to use it and it wasn't there (trauma had borrowed it because theirs broke) Was able to get the airway with DL and a bougie. Glad I knew how to perform DL

brendan c. -

Ron, Mel...??? no response? The sharp angle of the glidescope makes it difficult to pass the tube sometimes. I have found that not using the stylet can help to get the tube in (counterintuitive, but it works). Looking for other pearls....anybody??

Mel H. -

Yes - not using the stylet often works the next few months we have a series on the other devices and some pearls for getting past the cords...

Yen C., M.D. -

Tube delivery with hyperangulated blades are often challenging but there are tricks:

1) *****ensure good airway positioning: ear to sternal notch, face plane parallel to ceiling, ramped if needed, reverse trendelenburg in hi BMI, jaw thrust, head elevation at least 8-10 cm, external laryngeal manipulation (outsourced to assistant or bimanual laryngoscopy), 2x suction if needed

2) ensure tube delivery space, back out your view so that you see the glottic opening in the northern half of the screen, this shallows out the tube delivery angle so that you can enter the trachea easier (the deeper you go with the hyperangulated blade, your tube delivery points more upwards whereas the less deep you go, the tube delivery is less pointed upwards and conforms to the trachea which angles downwards)

3) always use the same shape of stylet as your blade (glidrite is great for the glidescope) to get to the glottic opening

4) use your tube delivery space on the screen to maneuver tube tip to the glottic opening

5) once you are there: pop and drop and right turn!!! Use a bevelled ski tip tube to avoid catching the rings. With the hyperangulated tube delivery, the tube tip interacts with the tracheal rings and the tube delivery points upwards which makes it hard to advance downward on the trachea. By popping the stylet tip out of the end of the tube, it softens the tip to allow it to maneuver down the trachea (like the old trach-light!). Using a ski tip bevel lessens the tube tip catching on trachea rings. Finally the BEST pearl is right turning your tube, turns the tube tip down and points the tube delivery downward so that you can drive the tube down the trachea.

All these tricks are thanks to Dr. Rich Levitan, his awesome cadaver course and FOAMed!!

By the way this is an old question so no-one might ever see it so I am posting it on emcrit google plus page for further feedback and tricks! Also will tweet it! Love the SoMed FOAMed! Any comments concerns tweet me @TBayEDguy !

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