Glide Scope

[ah2388]

Anyone out there using these yet?

The service which runs my school is hoping to get them soon, seems like it would help a lot to increase intubation success rate.

a video:
http://www.youtube.com/watch?v=VG-HFZuMi-A

from what im told they seem to be very expensive, I've heard as much as $10,000 for the scope/monitor. The blades have a cover which is disposable, then the unit is sanitized. Interestingly enough, this service has also gotten away from ET intubation in cardiac arrest, so this device would be used more often for the other conditions which require ET intubation.

Let me know what you think

-Adam

 

[MasterIntubator]

Its nice. Another great tool to have. We tend to use the Styletscope a bit more on difficult predictions. In a contest... they would probably be pretty close. The original stylet on the gluide is much better than the disposeable ones.
We try not to let this fancy technology get in the way of keeping our good ol' fashion direct laryngoscopy skills go to waste.

 

[ah2388]

do you agree that increased use of the glide scope would likely help to increase the intubation success rate of most services?

Based on your screen name, it appears that you're likely a skilled intubator, there are however as you know a lot of people who struggle with the skill. Part of the solution to this is an increased emphasis on training time so that medics are more efficient with traditional methods. That being said, wouldn't it make sense to make the job as easy as possible?

Please, if anyone has any input on some definitive cons please let me know!

 

[MasterIntubator]

I get to do a few intubations a day, so I guess I get a little more practice than the average bear.
It MAY improve the success rate, but... and a BIG BUT.... it is far more technologically advanced than the average laryngoscope, and if it breaks, power goes out, etc etc etc.. you need to be equally strong in the other methods. ( that goes to saying for any skill ).
Cons... one I can think of for in the field... the sun. Bright light upon the screen kinda throws your game off.
Batteries die out, your screwed too.... I can still intubate with a laryngoscope in ambient light, just more exciting.

It is not an answer for poor skills, as the most important part of it is recognizing that the tube is IN.... and stays IN. In which... no single machine will ever tell you ( radiographs are pretty reliable ). But in the field, you gotta use your brain with calmness.

 

[redcrossemt]

The GlideScope is pretty cool. It works. You need to practice with it though, because it is somewhat different than intubation utilizing manual laryngoscopy. I saw a resident have a really hard time using it the other day, just because he was unfamiliar with it and couldn't get the right angle on the tube.

For pre-hospital applications, you might also want to consider the AirTraq (www.airtraq.com). It's a disposable "video" laryngoscope that should cost less than $100 each. They have them in different sizes now. If you don't do a ton of intubations, this can be much more cost effective. However, if you had the choice, the GlideScope still has a much better view.

 

[VentMedic]

It is not an answer for poor skills, as the most important part of it is recognizing that the tube is IN.... and stays IN. In which... no single machine will ever tell you ( radiographs are pretty reliable ). But in the field, you gotta use your brain with calmness.

How true. In fact, to be able to use the Glide Scope in our hospitals one has to have achieved a high number of successful intubations and be considered an advanced intubator. It is definitely not meant for amateurs that have not mastered DL by the usual means.

 

[jtb_E10]

My service has a demo glidescope we received about a week ago. I think it is very neat, and would be great for the difficult airways, however..it kinda takes the challenge out of intubation...Still a great piece of equipment.

 

[ah2388]

I think a system that uses these could possibly institute a policy where the crews have to do x amount of hours in the OR where they pass x amount of tubes with a laryngoscope(spelling?) and this would be on an annual basis.

Ive heard that there are some medics out this way who don't really do more than 2-3 intubations per year, and I see this becoming even more and moreso with them getting away from intubation in cardiac arrest and moving more towards simplifying ventilation.

i see a lot of red in this post, so i apologize for the spelling/grammar errors

 

[wyoskibum]

I got to use one last week on a respiratory arrest call. It worked well. I like it.

 

[zmedic]

One problem is that people would likely not be as good at DL (direct laryngoscopy) if they are only using the glidescope. The glidescope is great, but you can get away with a lot more in terms of less than ideal head positioning. So there would be the concern that medics leaving the service that have a glide scope and then go to one that doesn't might find themselves in trouble.

Also again the price. I think as healthcare reform starts picking up steam EMS is going to be asked to cut costs. Cool toys like prehospital ultrasound, glidescope etc are likely going to have to have evidence based medicine guidelines (ie research) behind them to justify the cost. So some idea of lives saves, increases in successful intubation rates etc.

One of the nice things about hospitals is that resources can be centralized. So from a cost standpoint there is a big difference between putting three or four glidescopes in the OR vs putting them on each of a cities 50 ALS ambulances. (Hence the company giving you an glidescope to play with, they want you to love it. Beware of greeks and all that)

 

[wyoskibum]

One of the nice things about hospitals is that resources can be centralized. So from a cost standpoint there is a big difference between putting three or four glidescopes in the OR vs putting them on each of a cities 50 ALS ambulances. (Hence the company giving you an glidescope to play with, they want you to love it. Beware of greeks and all that)

My service has one unit that the supervisor carries in his flight car. We run EMT & Medic and our company policy is that we need a third person if we are going to place an ETT.

Generally the glidescope is used after attempts with laryngoscope and before placing backup LMA.

 

[kittaypie]

I heard you have to rock back while using the glide scope, has anyone had to do that while using this scope?

also, has anyone used a bougie? I used it a few times while intubating a dummy and found it worked really well.

 

[wyoskibum]

I'm no expert...

I heard you have to rock back while using the glide scope, has anyone had to do that while using this scope?

With a regular laryngoscope, your trying to get the best view of the airway as your looking into it.

With the glidescope, you just need to get the tongue out of the way for a good camera view. You shouldn't have to manipulate like you do with a standard blade.

 

[redcrossemt]

I heard you have to rock back while using the glide scope, has anyone had to do that while using this scope?

You don't have to rock back... There is definitely a different position than a laryngoscope, though. You actually don't want to rock back, and you don't want to push forward. Both of these would obstruct your view of the cords. You simply want to get the scope around the tongue. If you can't see anything, sometimes backing straight off a little will actually help.

also, has anyone used a bougie? I used it a few times while intubating a dummy and found it worked really well.

Bougies are amazing! Everyone should have one on your truck for the $10 or so they cost!

 

[MedicPatriot]

We have one. I haven't intubated anyone yet in 2 months ive been a EMTP so I can't speak on it. I have used it on cadavers though. Its very easy to use BUT you have to be trained because I have seen some people try to use it like a regular laryngoscope (head tilt back and pushing the blade forwards too hard). Also regular stylets suck with the glidescope, use the one that comes with it.

I plan on using this as a backup to direct laryngoscopy, but first line in difficult airways and sometimes trauma. I'm going to use this is my forst field intubation though, so I can't wait to see how it goes.

Oh yeah and with the glidescope it might be easier to intubate while chest compressions are being done.

 

[DrankTheKoolaid]

re

Just got a chance to use one for the first time yesterday in the local hospital OR. ( maintaining good relations with ED/OR/CRNA pays off). This was for a bronchoscopy patient so though she was a VERY small woman a 8.0 had to be used due to the bronchoscope itself. The technique was def different and i agree as even the brightlight of the OR was washing the monitor screen out. My Administrator is writing a grant as we speaks to procure 2 of these. Though I also just ordered a sample of a Vividtrac ( at breakfast and believe that is the name ) disposible units. Seem interesting, directly plug into lifepak and zoll via USB and make the monitor screen the viewing screen. We use Philips Mrx so not the big selling point for me though. But i think ANY video assisted intubation technique would be great to have to fall back on when all else fails.

 

[NomadicMedic]

I intubated a patient in the ED with a glidescope two weeks ago. Very different position used, but certainly nice to be able to see a full color pic of the cords as the tube passes through. I'm a fan.

 

[triemal04]

We have one. I haven't intubated anyone yet in 2 months ive been a EMTP so I can't speak on it.

So here's a question for everybody.

Intubating by direct laryngoscopy is a perishable skill; if you don't do it pretty regularly your ability will deteriorate. The Glidescope is definetly a nice tool to have, and makes most intubations much simpler when used correctly. But it is not the same as doing it the old-fashioned way; intubating with it is much different than without.

If a service that allready has low numbers for intubations (successful, first pass intubations) and places the Glidescope in service as either a backup, or front-line tool, should direct laryngoscopy be allowed anymore?

 

[wyoskibum]

Depends

So here's a question for everybody.

Intubating by direct laryngoscopy is a perishable skill; if you don't do it pretty regularly your ability will deteriorate. The Glidescope is definetly a nice tool to have, and makes most intubations much simpler when used correctly. But it is not the same as doing it the old-fashioned way; intubating with it is much different than without.

If a service that allready has low numbers for intubations (successful, first pass intubations) and places the Glidescope in service as either a backup, or front-line tool, should direct laryngoscopy be allowed anymore?

That is really a question for your Medical Director.

I know in my service, we have two devices shared by four ambulances. If we have an RSI job, we call for the supervisor who has one of the glidescopes. Usually, I will have my IV access and drugs drawn up and ready by the time the supervisor arrives. I will have them get the glidescope ready, but will start my intubation with the laryngoscope. I will use the glidescope if there is a problem with the direct laryngoscopy.

 

[triemal04]

That is really a question for your Medical Director.

I know in my service, we have two devices shared by four ambulances. If we have an RSI job, we call for the supervisor who has one of the glidescopes. Usually, I will have my IV access and drugs drawn up and ready by the time the supervisor arrives. I will have them get the glidescope ready, but will start my intubation with the laryngoscope. I will use the glidescope if there is a problem with the direct laryngoscopy.

Sure, but I just want to see what others think. And I always get what I want! :rofl:

Since that's the way you do it, do you think, or have you seen/heard of it affecting how you guys prepare for an intubation, especially in percieved difficult intubations? As in positioning, bougie, partner at the neck, suction at the ready, etc etc. Or are people just making a quick attempt and going to the Glidescope?

If it's only available for RSI's then maybe that wouldn't be an issue with your service. It's just something that always concerns me about the Glidescope.