Glidescope fail

[periopdoc]

sometimes military senior rank takes precedence in the decision of who-is-going-to-do-what (as long as it isn't completely illogical).

From my perspective, as a guy who has no probs "standing by" while my medicine colleagues have a go at an airway in the ICU... a surgeon "taking a look" after two anesthesiologists have failed to intubate is... completely illogical.

Unless it was an ENT

Glad I don't work in the military.

- pod

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[Noyac]

From my perspective, as a guy who has no probs "standing by" while my medicine colleagues have a go at an airway in the ICU... a surgeon "taking a look" after two anesthesiologists have failed to intubate is... completely illogical.


Glad I don't work in the military.

- pod

I agree POD, I will be more than happy to let anyone have a go at just about any airway outside of the OR as long as it won't burn my attempt. I figure if the ER docs, ICU docs etc are gifted at this then I will be called less often. Plus, its their department and Im a visitor. Basically, when I'm called to the ER for help I just bluntly ask, "what is it that you want me to do?" With that being said, I have had to step in at times and take over but not that often.

 

[dhb]

I think it's fine but i would tape it and put it up on youtube in a split second

 

[pgg]

Agree in principle. Things are a little different unfortunately when the surgeon is also the Director of Surgical Services, and an O-6, while everybody else in the room (including anesthesia) is south of the O-6 rank.

Ugh.

I've never had anyone attempt to pull rank over qualifications in the OR.

Our DSS is a nurse but he is very careful about not attempting to influence medical decisions. He's a good guy and has gone a long way toward restoring some of my faith that good senior military nurses and administrators exist. He's one of a very few O6 nurses I've known that insist on doing some clinical work every week.

 

[Noyac]

Ugh.

I've never had anyone attempt to pull rank over qualifications in the OR.

Our DSS is a nurse but he is very careful about not attempting to influence medical decisions. He's a good guy and has gone a long way toward restoring some of my faith that good senior military nurses and administrators exist. He's one of a very few O6 nurses I've known that insist on doing some clinical work every week.

Thats gotta be a strange environment where the senior ranking member is the lesser trained/educated.

In this case the surgeon was a female, right? I'm curious if this environment is more stressed when a female is involved this way. Flame away all you nay Sayers. I'm not as much of a chauvanist as you may think. But we have made our way through our share of difficult females in the OR director position, CNO, etc who have not been very skilled at handling a little authority. All I'm doing is asking the question.

 

[IlDestriero]

\

Agree in principle. Things are a little different unfortunately when the surgeon is also the Director of Surgical Services, and an O-6, while everybody else in the room (including anesthesia) is south of the O-6 rank.

Rank is no excuse for doing something that you know is wrong. When I was the department head at my little navy hospital and the O6 general surgeon wanted to do things he had proven to be horrible at (IJ, Picc lines) and things we were not really set up to do (thoracotomies, big cancer resections, etc) I just, respectfully, said no. The end.
If he wanted to be a d!ckhead he was going to have to have the CO call me and order me to do the anesthetic, against my medical judgement. And I told him that more than once. Good luck with that. You don't (usually) get to the CO level by being stupid.

 

[pgg]

Thats gotta be a strange environment where the senior ranking member is the lesser trained/educated.

In the military, you can add one more wrinkle to the rank issue - the possibility that the anesthesia provider might be a CRNA with no physician backup available.

 

[narcusprince]

I have a buddy of mine at MAMC. He is an Orthopod really sharp guy. He has had to intubate for his CRNA before. I was floored when he told me this. No way no go its my airway. Its like me saying hey Orthopod let me reduce that fracture I know you cannot get the right position from my N=1/2 fracture reduction as a MS3. If I say we cannot intubate lets move on to something else via the difficult airway algorithm. IE wake the patient up attempt an awake fiberoptic. But for gosh shakes Get Your Stinking Paws Off my Laryngoscope.

 

[Idiopathic]

we use the mcgrath handheld or storz videoscope and i always make the residents use a bougie along with it, even with a perfect view, ive just seen the tube get directed posteriorly too often. actually ive never used a true Glidescope(tm)

 

[pd4emergence]

we use the mcgrath handheld or storz videoscope and i always make the residents use a bougie along with it, even with a perfect view, ive just seen the tube get directed posteriorly too often. actually ive never used a true Glidescope(tm)

We tried all three and the two that you have are pieces of garbage. We got the glidescope later and it took me a while to figure out how useful a good video laryngoscope could be because my experience was so soured by the McGrath and storz.

 

[OB1🤙]

We tried all three and the two that you have are pieces of garbage. We got the glidescope later and it took me a while to figure out how useful a good video laryngoscope could be because my experience was so soured by the McGrath and storz.

The Storz C-Mac is just a mac blade with a video on it. That is, whatever your VL view is on the screen should be obtainable by DL. As a difficult airway tool, I feel that this is mostly useless. Storz does also makes a "D" blade for the C-Mac which is more curved, which is better as a difficult airway tool.

IIRC the C-Mac was intended to be used as a teaching tool so that the instructor could see what the trainee sees as they perform a regular DL.

 

[btbam]

The Storz C-Mac is just a mac blade with a video on it. That is, whatever your VL view is on the screen should be obtainable by DL. As a difficult airway tool, I feel that this is mostly useless. Storz does also makes a "D" blade for the C-Mac which is more curved, which is better as a difficult airway tool.

IIRC the C-Mac was intended to be used as a teaching tool so that the instructor could see what the trainee sees as they perform a regular DL.

^^^ Exactly. The C-Mac can take pics or video which makes it handy for training purposes, but it's not gonna help in a difficult airway scenario.

 

[IlDestriero]

^^^ Exactly. The C-Mac can take pics or video which makes it handy for training purposes, but it's not gonna help in a difficult airway scenario.

That's not exactly true, it has the camera at the end next to the heated light source. If you have somewhat limited opening, suboptimal positioning, larger tongue and/or redundant tissue you could have a poor view from above, but a good line of sight from the end of the blade.
The video laryngoscope is my usual go to blade for someone who looks good for intubation but has been described ash difficult at another Hospital, especially if they have grown since that time. If they are easy, I just do a normal DL, if the view is bad, I look up at the screen and take advantage of the camera. We see many "difficult airways" that are not.

 

[Idiopathic]

we use the storz that attaches to the fiboeroptic cart, very helpful in anterior airways, limited oral opening, excessive oropharyngeal soft tissue, neck instability

 

[Indydoc1]

Don't feel bad the glidescope can be extremely difficult to intubate with. The use of the Karl storz C-Mac for difficult airways has a much higher first pass success rate then the glidescope. I believe the reason for this is because of the smaller, lower profile blade on the CMAC system. The extremely curved glidescope blade and bulkier profile, will get you a view of the cords but will battle for space with the ett tube and make it more difficult to pass the tube. The extremely curved blade of the glidescope is also harsh on the airway anatomy. The Mac 3 or 4 blade on the CMAC will get you the indirect view that you need in an anterior airway, without an extreme curve on a stylet that the glidescope requires. Good luck!

 

[Bertelman]

...and thank you for that message from our sponsor, Karl Storz.

 

[IlDestriero]

Great first post man!
Cheers!

 

[WholeLottaGame7]

That's not exactly true, it has the camera at the end next to the heated light source. If you have somewhat limited opening, suboptimal positioning, larger tongue and/or redundant tissue you could have a poor view from above, but a good line of sight from the end of the blade.
The video laryngoscope is my usual go to blade for someone who looks good for intubation but has been described ash difficult at another Hospital, especially if they have grown since that time. If they are easy, I just do a normal DL, if the view is bad, I look up at the screen and take advantage of the camera. We see many "difficult airways" that are not.

I like the C-MAC for the same reason. That way I can put in the anesthesia record my view on the DL for future reference. At a teaching institution, 95% of the time I see a prior intubation using Glidescope I don't know if it was because of difficult (or perceived difficult) airway, or if it was for training purposes.

 

[IlDestriero]

I like the C-MAC for the same reason. That way I can put in the anesthesia record my view on the DL for future reference. At a teaching institution, 95% of the time I see a prior intubation using Glidescope I don't know if it was because of difficult (or perceived difficult) airway, or if it was for training purposes.

We usually put a comment about why we chose a non standard DL. Usually "elective fiber", etc.

Cheers!

 

[leviathan]

I'm assuming you don't want a surgeon to look because of a safety issue, and not because it would bruise your ego to let them try?

 

[Indydoc1]

Great first post man!
Cheers!

Thanks!!

 

[pgg]

Thanks!!

It wasn't a compliment.

Let's see. On your linkedin account page, you identify yourself as a "Sales Representative at Karl Storz Endoscopy" ...

But here, you're posing as a doctor. (You changed your status to "attending" just now ...)

I wonder what the FDA would say about a Storz sales representative pretending to be a doctor, making unsubstantiated claims about his product on a professional forum.

Go away.



(Credit to proman for tracking down the linkedin profile.)

 

[IlDestriero]

Thanks!!

Priceless.
Our Storz rep is smoking, btw. She can show me her Cmac anytime.

Cheers!

 

[Bertelman]

Priceless.
Our Storz rep is smoking, btw. She can show me her Cmac anytime.

Cheers!

She told me the curve on your Glidescope made it difficult to place.

 

[Metalblade]

How do you exactly use a howland lock? It looks interesting but never seen one.