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"Video Laryngoscopy" Needs to Die
Let the record show, this is not a debate for or against the use of video cameras on laryngoscopes. It’s not really a debate at all. It’s a plea. An honest plea…
The “DL vs. VL” debate has been had. It will continue to be had as our research evolves and our tools evolve (and we will participate). But, I beg of us as a community to pause and collectively consider a point of order: our discussion and debate, and worse our education of novice critical care providers, and even worse our research, is becoming marred by the fact that we aren’t all speaking the same language. We often throw around terms without RIGOROUS attention to detail.
LMA FOI - You Mean You Can Intubate through that Thing?
Emergency airway management is being revolutionized. Think about it…those of us who are in training now are being exposed to some very different core skills. The big culprit is the recent advent of video laryngoscopy – not much argument there.
With that said, I will argue that almost as significant as the advent of video laryngoscopy from a general “airway management revolution” perspective is the philosophical change of many pre-hospital providers in that it is becoming the norm for extra-glottic devices to be placed primarily, or at least considerably more often than in the past.
It is likely that the rate of field placement of extra-glottic devices will become more common. Thus, we will probably see many more patients present to the ED in whom EMS has placed an extra-glottic. As we recognize the power of extra-glottic devices, I think that even the most advanced airway managers will use extra-glottic devices with more frequency to facilitate rescue oxygenation and ventilation.
This begs the obvious question: should we remove these devices after they are in and working?
Rescue Me
Extraglottic devices are often term "rescue devices." And I can't decide whether this is a term that glorifies or degrades. While yes they can often save your tail after a failed attempt at direct or video laryngoscopy, they can do so much more. Running a code in a resource limited setting with 2 providers? The gold standard of 2 person bag valve mask technique ain't going to be an option for you. And you think you can hold C-E mask seal while bagging for 20 min? If you can, you must have hands that rival the late great Andre Rene Roussimoff...