Video stylets

[izzygoer]

I am interested in any opinions on the use of video stylets in emergent intubation difficult /airway (blood/gastric contents).

Levitan, Clarus ainc or reviews on other makes? Thanks

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[agammaglobulin]

I have only used "GlideRite" which is a rigid stylet that works for the 'hyperacute' angle blades. So McGrath X-Blade and Glidescope. Hope that helps.

Remember, anytime you are using a videolaryngoscope in a soiled airway there's a chance that the lense will get dirty and you'll lose your view. For this reason, DL w/ Bougie might be better than video

 

[deleted697535]

Never used one in that setting but on the whole video in soiled airway bit...

There was a link on here to a great video on videolaryngoscopy in a soiled airway. Copious use of suction first obviously and then leave the suction in the left side of the mouth, to the left of the blade.

 

[POW16]

Never used one in that setting but on the whole video in soiled airway bit...

There was a link on here to a great video on videolaryngoscopy in a soiled airway. Copious use of suction first obviously and then leave the suction in the left side of the mouth, to the left of the blade.

Are you thinking about SALAD ?

Podcast 196 - Having a Vomit SALAD with Dr. Jim DuCanto - Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding

 

[deleted162650]

I can’t believe someone is claiming credit for “inventing” leaving a yankaur in the mouth while intubating and even went so far as to come up with a stupid acronym for it. TOOL.

 

[AdmiralChz]

Are you thinking about SALAD ?

Podcast 196 - Having a Vomit SALAD with Dr. Jim DuCanto - Airway Management Techniques during Massive Regurgitation, Emesis, or Bleeding

Neat trick, but seems awful cumbersome (especially for providers who don't do a large amount of intubations) versus just doing a DL as usual. Most places teach a two-suction technique for tonsillar/posterior oropharyngeal bleed intubation so this is hardly groundbreaking stuff.

Also SALAD as an acronym is ridiculous, like come on. I'd like to... well, pitch that one out. I'll avoid the use of "toss."

 

[deleted697535]

I don't know. I like it. Maybe you all have concrete game plans in your mind for when faced with this situation but I definitely did not. I've only had a few bad bleeding tonsils or airways like less than 5, and this definitely helped me think more organized about when this fairly rare event may occur whether it's dl or vl

 

[narcusprince]

Double suction setup. If your concerned about esophageal or full stomach precautions where aspiration risk is high drop a ng tube keep it to suction. This salad technique will not be great for tonsiler bleeding. 1 cricoid pressure 2 trendelenburg position. 3 double suction with suction to ng.4 suction the oropharynx5 proceed with intubation.5 suction et tube at the end. I only know a few ladys that could accomidate all that hardware im their mouths as shown in the salad technique. I do like the simulation involved.

 

[Groove]

I am interested in any opinions on the use of video stylets in emergent intubation difficult /airway (blood/gastric contents).

Levitan, Clarus ainc or reviews on other makes? Thanks

We have a Clarus Levitan in the ER and it's a great tool for anatomically challenging anterior airways, cervical fusion, s/p ACDF, limited neck mobility, etc.. It's shorter than the Shikani which makes it easier to use in conjunction with traditional DL. With the Shikani, you've got this gigantic fencing foil and your body position looks like a Tai Chi pose. It's easier to just use the Levitan in place of an ETT stylet because you don't have to crank your hand back as far and can go from direct line of sight to the video stylet, pull the blade out and just drive from there. It wouldn't be my first choice with a variceal bleed or heavy gastric contents/secretions because it's easy for your vision to become obscured, even with adequate suction. I'd probably reach for a glide or McGrath in those cases before I'd go for the video stylet.

My main complaints with the device lie in the prep time where you need to trim the ETT to 28cm. (Unlike the Shikani) That's probably not as big a deal to you guys who often are already prepped in advance or have more time to set up. As an ER doc, usually when I'm going to need it, I need it 5 minutes ago and it's precious moments lost that I'm spending cutting off a few CM of the ETT prior to loading it on the stylet. If I've got time then it's not as big a deal but I still find it annoying. I'm probably in a minority. I think you can buy certain ETT at 28cm but I haven't gone through the trouble researching/buying them.

 

[izzygoer]

We have a Clarus Levitan in the ER and it's a great tool for anatomically challenging anterior airways, cervical fusion, s/p ACDF, limited neck mobility, etc.. It's shorter than the Shikani which makes it easier to use in conjunction with traditional DL. With the Shikani, you've got this gigantic fencing foil and your body position looks like a Tai Chi pose. It's easier to just use the Levitan in place of an ETT stylet because you don't hav to crank your hand back as far and can go from direct line of sight to the video stylet, pull the blade out and just drive from there. It wouldn't be my first choice with a variceal bleed or heavy gastric contents/secretions because it's easy for your vision to become obscured, even with adequate suction. I'd probably reach for a glide or McGrath in those cases before I'd go for the video stylet.

My main complaints with the device lie in the prep time where you need to trim the ETT to 28cm. (Unlike the Shikani) That's probably not as big a deal to you guys who often are already prepped in advance or have more time to set up. As an ER doc, usually when I'm going to need it, I need it 5 minutes ago and it's precious moments lost that I'm spending cutting off a few CM of the ETT prior to loading it on the stylet. If I've got time then it's not as big a deal but I still find it annoying. I'm probably in a minority. I think you can buy certain ETT at 28cm but I haven't gone through the trouble researching/buying them.

Thank you Your response is appreciated. My interest in this device is specifically for bloody and messy airways on the floor/Er. But in your use you believe the video Laryngoscope is better than a stylet in these situations ? I thought the theoretical benefit of the video stylet was that it could be placed by direct vision under the epiglottis thereby bypassing the other contents in the oral cavity that the glide scope must traverse to get in position.

I’ve had a grade 4 airway that was jackknifed by a floor attending who caused a pharangeal tear. Mouth was not full of blood but there was enough that The glide camera kept getting covered when put in. Have wondered if a video stylet with plain DL would have offered an advantage here. Thanks

 

[Groove]

Thank you Your response is appreciated. My interest in this device is specifically for bloody and messy airways on the floor/Er. But in your use you believe the video Laryngoscope is better than a stylet in these situations ? I thought the theoretical benefit of the video stylet was that it could be placed by direct vision under the epiglottis thereby bypassing the other contents in the oral cavity that the glide scope must traverse to get in position.

I’ve had a grade 4 airway that was jackknifed by a floor attending who caused a pharangeal tear. Mouth was not full of blood but there was enough that The glide camera kept getting covered when put in. Have wondered if a video stylet with plain DL would have offered an advantage here. Thanks

I would say it's definitely a useful adjunct to a difficult airway kit and very portable but my only hesitation would be within the context of using it as a sole intubating device in an already established messy/bloody airway where the stylet view definitely can get obscured. If I were you, heading to a messy floor code or responding to the ER, I'd honestly probably carry a McGrath and a Levitan to use in conjunction with the video laryngoscope. That way, you've got the best of both worlds (on top of them both being light and portable) and even if you don't need to look through the Levitan, you can use it as a rigid intubating stylet. You can intubate with the stylet alone, but it takes a few seconds more getting your bearings once you pass it along the base of the tongue to the epiglottis with jaw lift. It's easier when you are using a laryngoscope and can place the stylet about 1-2 cm behind the epiglottis before switching views and then you have already established landmarks and can more easily navigate.