Has Video Finally Killed DL?

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Has Video Finally Killed DL?

More than 1.5 million adults undergo tracheal intubation outside of the operating room each year in the United States. Traditionally, this has been performed with direct laryngoscopy, where a clinician displaces the patient’s tongue and epiglottis with a laryngoscope blade to visualize the vocal cords through the mouth, allowing for direct visualization of the passage of an endotracheal tube. An alternative method for tracheal intubation is video laryngoscopy, where a camera on the distal half of the blade transmits an image to a screen allowing for indirect visualization of the vocal cords and passage of an endotracheal tube without direct line of site.

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Grand Rounds Recap 10/14

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Grand Rounds Recap 10/14

Reviewing our own neuroimaging just got a little easier with expertise shared by Dr. Knight. Trauma resuscitations just got a little more evidence-based with Journal Club covering VL>DL, IO>IV, and arginine vasopressin administration. Our kindness, attitude, and desire to take breaks all can improve with the help of Dr. Li’s R4 Capstone. Finally, Quarterly Sim/Oral Boards covered the spectrum of pediatric DKA with cerebral edema, to PTA, to trauma in the elderly, highlighting the breadth and depth of emergency medicine.

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Nobody Expects the Spanish Inquisition! (or, for that matter, the Cormak-Lehane Grade 4 Laryngoscopic View!)

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Nobody Expects the Spanish Inquisition! (or, for that matter, the Cormak-Lehane Grade 4 Laryngoscopic View!)

A 68 year-old man presents by squad with shortness of breath.  He is noted to have a nearly quiet chest with very poor air movement, to be using accessory respiratory muscles, and to be slightly lethargic.  Quick perusal of old records discloses a history of severe COPD, steroid and O2 dependence, HTN and ulcer disease.  The squad reports that his O2 sat was 86% at the scene, improving to 92% on a NRBM and two nebs.

His vitals are:  p 138, r 22 and labored, bp 156/96, O2 sat 92% on a high-flow NRBM.  His POC renal returns with a pCO2 of 88.  His estimated weight is about 175 lbs.

A decision is made to intubate. 

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