Quick Trache II and KingVISION
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Can't say about the King Vision, but my experience (granted its all been sim/cadaver) with any cric that requires multiple parts to work is a loser.
Brandon O
Puzzled by facies
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We use the QuickTrach, but about as often as you'd imagine.
NomadicMedic
I know a guy who knows a guy.
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We also use* the QuickTrach. Trialed the KingVision. I don't think we've made a decision on VL yet.
*use=carry in the bags.
*use=carry in the bags.
Christopher
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We've gone from QuickTrach to Bougie Assisted Cric's recently.
At one service we're possibly getting the Glidescope Rangers, at another service we're working on budgeting the KingVision plus some cadaver lab time.
From my cadaver time (n=5-6 different ones) and human time (n=1):
KingVision pro's:
- Cheap
- Channeled
- Works without modification on most airways
KingVision con's:
- Very tall, must disconnect video and channel for larger folks
- Different mechanics from traditional DL means you must train people how it works and also how it fails
- Interesting exit angle makes hitting the trachea difficult sometimes, bougie assistance is useful (and if the coude tip is going quite anterior you'll need to use a crankshaft maneuver)
- Requires a decent amount of mouth opening
Compared to a Glidescope it is probably a better option for EMS (cost, simplicity).
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NomadicMedic
I know a guy who knows a guy.
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I'm a fan of the VUstik, a lighted, camera stylet. It's inexpensive, simple and doesn't change the method of intubation. It's a very cool device.
RocketMedic
Californian, Lost in Texas
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I personally think that needle crikes are worthless.
blindsideflank
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^^^ because?....
We have quick trache and it is fine but our service has added a scalpel to the box because of issues with getting through the skin. This is probably due to not anchoring the skin but either way the scalpel has resolved all issues.
If no scalpel then you can use the needle like a pen to make a quick incision through the skin
Ours are not cuffed so I would prefer our option of scalpel and a real tube
We have quick trache and it is fine but our service has added a scalpel to the box because of issues with getting through the skin. This is probably due to not anchoring the skin but either way the scalpel has resolved all issues.
If no scalpel then you can use the needle like a pen to make a quick incision through the skin
Ours are not cuffed so I would prefer our option of scalpel and a real tube
Christopher
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A big issue with needle crics is you're merely oxygenating but not ventilating the patient. You can't just stop with the needle cric, you need to convert it to a larger catheter.
As for the QuickTrach, it isn't quite like a needle cric in that you have a large enough diameter catheter to do some ventilation. However, it doesn't come with useful means of converting to a full cric like a Melker kit would. You also have to really ram a QuickTrach into the tissue, it isn't as easy as you'd think with such a large trochar.
If you're going to include a scapel you ought to switch to a pure surgical cric and perform a bougie-assisted cric. Less steps, less equipment. Less is more in an ultra rare skill.
lightsandsirens5
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Eh, buys you a few minutes at most. Great if you are right next to the hospital.
I am a fan of full blown surgical airways on the truck. You NEVER need one, but when you do, might as well do it right.
polisciaggie
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I used a King Vision just the other day in a cadaver lab and it worked great! Out of all the video laryngoscopes I've used it is probably the best one for EMS in my opinion. I was able to intubate a grade IV patient in about 10 seconds.
The only problem I had with it was that the tube I was using didn't want to slide down the channel, but we may have been using the wrong size tube.
The only problem I had with it was that the tube I was using didn't want to slide down the channel, but we may have been using the wrong size tube.
King Vision, it works like a charm. You cannot hold it like a regular blade handle though, you have to hold it lower almost ont he blade itself. The technique is also different, there is not lifting, more of a slight rocking back motion. Hard to explain, but you will see what I mean. If you use it like a traditional blade, you will put it in the esophagus.
The King Vision has increased our first pass success rate, and gets even the hardest tubes.
Oh, and make sure you always lube the tube. It is plastic on plastic when it sits in the device and does not slide very well.
We use a bougie assisted in-house design fro surgical Crics
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NYMedic828
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Never heard of or seen the King Vision before you mentioned it.
That is really cool. Mini glidescope.
That is really cool. Mini glidescope.
MSDeltaFlt
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I'm old school. And there's no school like the old school. A blade and a tube are always better than some thingamajig. Same goes for any VL device.
Technique is everything. Kinda like kissing on a date. If you're doing it right, you'll KNOW you're doing it right. If you're NOT doing it right, you'll KNOW you're not doing it right.
And I may rub some folks the wrong way, but I honestly believe bigger and better mouse traps are usually needed for those who don't really know how to catch a mouse in the first place.
Technique is everything. Kinda like kissing on a date. If you're doing it right, you'll KNOW you're doing it right. If you're NOT doing it right, you'll KNOW you're not doing it right.
And I may rub some folks the wrong way, but I honestly believe bigger and better mouse traps are usually needed for those who don't really know how to catch a mouse in the first place.
I disagree, technology is there for a reason. To advance you forward, like everything in Medicene, we have advanced. I like the VL much more than I ever liked "old school" it is faster, safer, and it tackles even the most difficult airways with ease.
I believe in supplying the tools for the job that will get your tube fast, safe and the first time. Especially since most Medics get on average 10 intubation attempts a year.
Sublime
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Guess it depends where you work, but I'd say that number is being generous.
NYMedic828
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Probably had about 15 in NYC in the last year.
Maybe 20 total intubated patients but I didn't do them all.
MSDeltaFlt
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The reason(s) why "most medics" who get said average 10 ETT's per year? Simple. They don't retrain. Regardless of clinical field regardless of level of expertise, the teachers, leaders, innovators, trail blazers will teach technique over and over and over again until those learning are blue in the face... and then they keep going over it some more.
And the phrase "getting a tube" when referencing airways (please believe me when I say I do not want you to feel I'm singling you out), is one reason why these new gadgets (I call "crutches") are needed. Now Grade 4 airways are extremely difficult and even the masters (MDA's and Laryngoscopists) won't get them all. Because there is a big difference between "getting a tube" and "getting an airway".
The key to all of this is:
Slow down/"ooh-sah" (read: don't rush)
Maintain your situational awareness
Use proper technique
In that order.
Remember, Grade 3's & 4's are not that common. The majority of the problems I've seen with intubations (witnessed, first hand [yes I'll admit], chart review, and case study) have all been because of a lack of the aforementioned above. The patient being the cause would be an even more rare occasion.
And because focus has been turning more towards those rare instances that fall beyond technique, technique in and of itself is being disregarded more and more. And I honestly believe it is a great disservice to ALL medics by doing this.
At some point in the future, these gadgets will be the new normal. We didn't have the EZ-IO, IN pain meds, narcan, etc. back in the day. What about the veinlite and dopplers for getting lines in the hospital? I'd rather have technology available that takes skill out of the equation, making it irrelevant rather than rely on providers to do the skilll that they may have the opportunity to do maybe once or twice a year in some places.
I worked in NYC like NYmedic828, and got a tube every week or two, by virtue of all the nursing homes and traumatic arrests in the area. I've had to digitally intubate a few difficult airways (I have long fingers, so it's easy for me, particularly since we have bougies now), but I would rather have the technology available to virtually guarantee a 100% success rate.
Yes, I think I have only five this year. I could have had a few more, but the medic officer on those calls dropped the "tube of shame" after failed ETI (the King).