In Defense of the Hyperangulated Blade

Let me begin, as is my wont, with a story. Let's say, for the sake of discussion, that I was moonlighting at Janus General Hospital. I had a patient signed out to me by my partner: a young patient with COPD, influenza, and pneumonia. He was on BiPAP and supposedly stable waiting for an ICU bed. Murphy's law being what it is, immediately after my partner left, the patient deteriorated and clearly was going to require intubation. He had all the predictors of being a tough tube, so I made sure to have my back-up plans articulated and ready to go.My go-to technique for quite a few years is video laryngoscopy (VL) with the hyperangulated blade of the GlideScope. My back-up is direct laryngoscopy (DL) and my ace-in-the-hole is the gum bougie. I'm not a huge fan of fancy tricks like awake intubation (too much work, and I'm lazy) and in any event, this guy was too sick for that. Since this was a daunting airway I made sure to have all the stuff ready to go, including our quick cric tray.I couldn't get the tube with the GlideScope. While I had a nice view of the larynx, there were frothy secretions welling up through the cords so quickly that between the time I suctioned and tried to place the tube, I lost my view. Faced with crashing sats, I tried to bag him back up, but couldn't ventilate. I got his sats from 50% all the way up to … 75%, and he clearly wasn't going higher. So I had my partner prepping the neck while I went back to the old stand-by, DL, and I was able to snake the ...
Source: Movin' Meat - Category: Emergency Medicine Source Type: blogs