Category Archives: Video laryngoscopy

Endoscopy, Equipment, Intubation, Rigid scopes, Video laryngoscopy

Split-screen dual endoscopy

Some new devices/monitors such as the Glidescope Core or Storz CMAC 8404 now allow viewing two video feeds on one display, either as a “picture-in-picture” or side-by-side display. Here is a demo of split-screen dual endoscopy with Macintosh-blade VL and optical stylet:

Dual endoscopy using split screen. It would have been good to have warmed the optical stylet (right) to prevent fogging of the lens. Orienting the VL on the left and stylet on the right improves coordination between left and right hands holding the devices.

For more discussion on dual endoscopy, see the original post from 2018 here on OpenAirway which is being updated over time.

Lectures, Video laryngoscopy

DAS 2021 – Awake Video Laryngoscopy

Selected references can be accessed online via the links here. If you are unable to access a reference, or wish to download a larger set for furhter reading, please click the link for the archive at the bottom.

If you’re struggling access the articles above or would like an EndNote library and further references, you can access a share folder here.

A brief video describing a challenging case managed with awake VL using the CMAC Video Stylet is shown below. (Video prepared for the 2021 Virtual Guy’s Airway Management Course)

Guidelines, Intubation, Physiology, Video laryngoscopy

COVID Airways Podcast on Critical Care Scenarios

I was honoured to be invited back on the Critical Care Scenarios (@icuscenarios) podcast, to chat this time about airway management in COVID-19, but also talking about how it’s helping to focus improving our emergency airway management in general. Check it out at this link:

http://icuscenarios.com/episode-37-airway-management-for-covid-19/

Endoscopy, Rigid scopes, Video laryngoscopy

Dual endoscopy demo

Video

Here’s a brief clinical example of dual endoscopy using the CMAC VL and VS (video stylet).  This case was performed for teaching purposes, rather than a difficult airway.  Note the endoscopic view appearing as a picture-in-picture is from the editing; the images are on two separate displays.  (It starts a little late due to the author forgetting to press the record button on the device).

 

AirwayHowTo, Endoscopy, Rigid scopes, Video laryngoscopy

Dual endoscopy

“Dual endoscopy” refers to using two devices – usually a video laryngoscope and a rigid or flexible endoscope – to manage an airway.  The Bonfils (or Shikani or Levitan) optical stylet is often used in this context.  Performing dual endoscopy provides “three levels of protection”:

  1. If the glottic opening is easily seen with the laryngoscope, the rigid endoscope simply acts as an ideally shaped or steerable stylet to introduce the tube
  2. If the view is poor (CL grade 3 or 4), the laryngoscope can be used to guide the tip of the ETT and endoscope “into the ballpark”, and then the final positioning of the tip of the tube through the vocal cords is achieved with the endoscope.
  3. If the airway is badly soiled or swollen (eg. ongoing bleeding or angioedema), the endoscope can be used as a lightwand for a transillumination technique.  (Remember lightwands, anyone?)

Here’s a brief informal video explaining the first two points, using the CMAC VL/VS:

Another dual endoscopy approach is “VAFI” (video-assisted flexible/fibreoptic intubation), where a VL is used to help place a flexible endoscope, whereafter the rest of the intubation is continued using the flexible.  Several good case reports of this technique are described in the literature.

Here’s a brief clinical example of dual endoscopy using the CMAC VL and VS (video stylet).  This case was performed for teaching purposes, rather than a difficult airway.  Note the endoscopic view appearing as a picture-in-picture is from the editing; the images are on two separate displays.  (It starts a little late due to the author forgetting to press the record button on the device).

 

Some of the newest devices (eg. CMAC 8404; Glidescope Core monitors) allow both images to be displayed on the screen simultaneously, either as a “picture in picture” view, or side by side. If using the latter, orientating the images so that the VL is on the left and endoscope on the right is convenient, as this matches the two hands being used. Here’s an example, again in a patient with an easy airway, but simulating CL3 view:

Dual endoscopy using CMAC3 and Bonfils. It would have been good to have warmed the Bonfils before starting, to prevent the fogging of the distal lens.
Endoscopy, Intubation, Video laryngoscopy

VLVids: Intubation in Spinal Immobilisation

Video

Clinical video demonstrating a collection of techniques to facilitate elective intubation for a patient with an unstable cervical spinal injury in caliper traction.  Note the sideways introduction of the VL blade due to limited space for the VL handle, optimisation of the view (‘Rule of 3’), use of a coude-tipped bougie (introducer), and the 3-part technique to advance the endotracheal tube when it catches on the arytenoid cartilage (pull tube back to disengage, rotate 90 degrees counterclockwise, advance tube).

Algorithms, Equipment, Guidelines, Intubation, Lectures, Paediatric, Video laryngoscopy

NAPEM’17: Paediatric Difficult Airway in the ED

As promised/per usual, here’s my presentation from the current National Assembly on Paediatric Emergency Medicine, being held now (16-19 Feb 2017) at the Apollo Institute of Medical Sciences & Research, Hyderabad, India.  Much of the content is in the audio, of course…which I will post if/when available.
Comments welcome below as usual!

AirwayHowTo, Intubation, Lectures, Video laryngoscopy

Understanding airway geometry: Brainchildren of Dr Kenneth Greenland

One of the greatest influences on my understanding of the geometry of the airways, and thereby the technical skills and processes required to place airway devices of all types, has been the work on publications of Dr Kenneth Greenland. Greenland’s publication in the BJA in 2010 should be required reading for anybody who performs intubation. However, if you want to really understand theories of the airway curves and columns, I highly recommend getting it from the horses mouth.  Here below are several videos in which can Greenland explains his thinking and theories.  While they are a little longer than your average #FOAM material, I cannot recommend them strongly enough.

https://www.youtube.com/watch?v=VAhmohUI9R8

https://www.youtube.com/watch?v=p2Xcm7csV5w