May 31, 2017
Here it is! The series finale of "Tips For The Occasional Intubator". Tip 5. Video Laryngoscopy It’s no doubt that video laryngoscopy (VL) is sweeping the nation. While there are some resistors, the majority of providers have moved towards utilizing VL for their routine intubations. The VL tool comes in many shapes and sizes, and each one provides a little something different. Hyper-angulated blades allow you to “peak” around the corner with very little displacement of tissue. The standard geometry blade allows you to use the tool like DL, but optimize your view and allow your colleagues to see what you see. For these reasons, I have personally adopted VL into my routine practice. I have seen the success rates of my service DRASTICALY improve with this addition. I have seen some studies that show no difference between DL & VL. My only argument against these studies, is that the services that are cooperating in the study have high exposure to intubations. The question isn’t whether VL is better than DL, but rather are we practiced enough to effectively use DL. Tip 6. Simulation “The mannequin is nothing like the real thing!” This phrase comes out of most student’s mouth as they walk out of the operating room after clinicals. The truth is, they’re right! But, I don’t think the actual procedure of intubating is that difficult, and it’s certainly not the most dangerous. The part that we need to practice is the steps leading up to intubation, and the monitoring afterwards. No one dies from someone missing a tube and recognizing it right away. People die when the heuristics and planning fail to recognize failure. Guess what? This part we can simulate! Students routinely go into the OR and nail an intubation under the proper set up of an anesthesiologist. It’s required to complete clinicals! This right here tells me that we are capable of performing the skill, we just need help with knowing when to do it, and optimizing the conditions we perform it in. So there you have it… Our 6 tips that I have adopted into my occasionally intubating first pass success.