I'm an E.M. attending but value most an anesthesiologists' opinion in general but even that much more when it comes to airway.
so after i thought i had this all figured out: (glidescope easy, therefore my backup), i've had a couple cases where i have a hard time passing the glidescope into the pharynx past the tongue. usually it's when it's a smaller blade size like a size 3. i used a size four but the patient had a very small mouth opening so i went with a three, after pressing on the patient's tongue mutiple times because i couldn't pass it through, I finally i got a good view of the cords. i felt it should've been a litte smoother. any advice.
greatly appreciated.
Painter, you are an E.M. attending, so I will assume you had already optimized your conditions with paralysis if appropriate for this patient, and that you had the patient positioned the best you could. Basically approach it like you would a standard DL.
Having done all of that, it's as Noyac said: keep the Glidescope blade in the midline. I usually don't even look on the screen until the tip disappears from view.
As Bertelman said, consider starting with the size 3 blade. You'll be amazed at how well that works for many situations.
Are you using the disposable plastic sheath type blades, or the reusable actual blue plastic blades. During residency we had the reusable blue plastic blades that had to be cleaned. Where I am now we have the disposable sheaths. In my opinion, you need a little more mouth opening with the plastic sheaths.
Don't forget to take a deep breath and take a look at the actual amount of time elapsed. Sometimes things feel like they take forever, but in reality don't take longer than usual. I remember during residency feeling my heart rate increase when experienced E.M. attendings called for help with an airway. It increased even more when an experienced anesthesia attending and the chief resident in anesthesia called me for help one time. Adrenaline distorts time. Better to take your time and approach it systematically. If you do that it will take less time and be less traumatic than if you force or rush things. Blood and secretions in the airway can make your Glidescope view worse, particularly if they occlude the lens.
Don't forget, you can still do standard maneuvers like BURP, cricoid pressure, positioning changes, etc. to improve your view.
That's about all anyone can say on the internet without having been there next to you. Your comfort level and skill with the Glidescope will increase with time the more you use it. That time when the anesthesia attending and chief resident called me, I succeeded with the Glidescope where they failed. It wasn't easy, but it worked. I don't know what I did different than them.
It's sort of like DL. You can talk all you want and understand the theory, but there are small, hard to identify, things that change in your technique with time that increase your success rate.
Good luck!
