Do You Guys Have Video Laryngoscopes?

[Coastie]

Reading the thread on the field combitube of an obese patient, I was just wondering if you guys have video laryngoscopes?

Glidescope, McGrath, etc...

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[Paseo Del Norte]

Reading the thread on the field combitube of an obese patient, I was just wondering if you guys have video laryngoscopes?

Glidescope, McGrath, etc...

We have been using the King systems Airtraq for a year or so with mixed results. However, it is not exactly a video laryngoscope.

http://www.kingsystems.com/PRODUCTS/AirwayDevices/AIRTRAQ/tabid/198/Default.aspx

I understand our clinical gurus have pushed for the Glidescope.

 

[Altruist]

Reading the thread on the field combitube of an obese patient, I was just wondering if you guys have video laryngoscopes?

Glidescope, McGrath, etc...

I picked up an occasional shift at a rural county EMS that had the Glidescope--I think that was the one, it was a plastic, disposable unit. But they only had 1 ALS provider in the whole county, driving a quick response vehicle to meet up with volunteer BLS units... they only had to buy 1 or 2 at a time, so it wasn't too expensive to outfit the service with them.

Where I worked full-time, it was a larger service, and the expense of equipping all the ambulances with them would have been too much. As it was, we had combitube for backup and surgical cric for extreme backup.

I was never in a situation where I had to use the Glidescope, but they seemed pretty slick. As the price comes down, I imagine they'll become the standard for difficult airways. Probably start off in flight services and the like, as these things usually do.

 

[DitchDoc73]

My department has looked at them, but the cost is currently prohibitive for implementation. They chose instead to go with the King Tube as the airway of last resort.

 

[Paseo Del Norte]

Speaking of the King LT, LT-D, & LTS-D, anybody else hear that King got their pp smacked by the FDA over false product claims. Seems the King is approved as an anesthesia device by the FDA and King has been marketing it as a pre-hospital device. I guess the FDA took offense?

I guess there is always off label use?

 

[Dwindlin]

Speaking of the King LT, LT-D, & LTS-D, anybody else hear that King got their pp smacked by the FDA over false product claims. Seems the King is approved as an anesthesia device by the FDA and King has been marketing it as a pre-hospital device. I guess the FDA took offense?

I guess there is always off label use?

When this 1st came up there was an interesting debate about it in one of the ACEP's listserv's that I am subscribed to. From what I gathered from the discussion apparently a lot of the airway devices we use pre-hospital are done off label. So I don't know that the FDA making a big deal out of it matters a whole lot. Seems that it just changes the way King can market it.

And more on topic I think like most people the dept's I work/worked for have looked at them, but just not cost beneficial. Also, I actually don't care much for them, I would guess that it's just because I don't have a lot of experience with them, but the little time I was given to play around with them I didn't like them.

 

[Altruist]

I was never convinced the king airways had any huge benefit over the combitube. The only cool thing someone showed me was inserting a bougie-like stylet through the king into the trachea, pulling the king out, and threading an ET tube over the stylet. Expensive way to intubate, though; and wouldn't make much sense pre-hospital if you were getting good ventilation with the King itself.

Back to the video equipment... If equipment like the glidescope ensures a high success rate even for unskilled operators, and it becomes widespread, I wonder how that will change the debate over prehospital intubation?

 

[Paseo Del Norte]

Hey, I am not saying the King does not work, I just found it interesting that the FDA put the smack down on King. In fact, as stated I think very few devices can be officially advertised as pre-hospital alternative intubation devices. The combitube comes to mind.

I agree that the King does not really have any improvement over the combitube IMHO. As stated, I agree that I would never attempt to use a bougie to transition a functional supraglottic device to an ETT. I would have a hard time explaining why I pulled a perfectly good device in the theoretical attempt to place an ETT. High risk, low return IMHO. Perhaps I am just a combitube purist.

Back to the discussion: In my area of the world, I am starting to see a big push toward fiberoptic and video based techniques. I just returned from a trip to Texas where I was teaching a critical care transport orientation course and met a paramedic who worked for a back country EMS service with two ambulances total. His service managed to place a Glidescope on each ambulance and the medic quoted a price of less than $10,000 per unit. As the prices continue to decrease, the return on investment will continue to appeal to more and more services. In addition, with the proliferation of non-volatile flash memory and video recording, we now have the ability to recored our intubation. We now have video evidence, and when married with waveform capnography, you have a solid method for determination of placement.

 

[Coastie]

Thanks for the replies.

I don't think fiberoptics would be good in the field, but bring on the glidescopes.