Optical stylet intubations two ways by Master DuCanto

Here are two videos of intubations using optical stylets : The Clarus Video Stylet via an AirQ SGA and the original Levitan FPS stylet ( from which the Clarus VS is modelled)

 

Note use of Oxylator for preoxygenation and the S Shaped bend Jim molded the Clarus VS into to facilitate passage down the AirQ channel.

 

Note use of Glidescope to visualise epiglottis, then use of Levitan stylet to endoscope the trachea

 

Relevance to Prehospital and Retrieval medicine:

So what I hear you cry? DuCanto has the luxury of a nicely lit OR with assistants , an anaesthetic machine and monitors to boot. What about my work where I fly into remote clinics and rural hospitals or some cattle station? The fact is that I am aware of at least two Australian retrieval services who do carry the airway gear to do¬† intubations via a LMA/SGA. Cliff Reid’s service has adopted airway gear to intubate via an iGel SGA using a flexible endoscope, the Ambu Ascope. MedStar of South Australia, have for a while been able to carry a flexible fibreoptic bronchoscope and used it successfully in a case of severe clot aspiration post tonsillectomy in a small rural hospital. My service carries the Levitan FPS stylet and this enables us to tube via a LMA. So if a rural nurse of doctor has already placed a LMA before our team arrival, we have options of how we can manage the airway for transport. We can leave the LMA in if it is working fine. We can tube via the LMA using the Levitan for guidance of a bougie or as a stylet. Sure you could just pull the LMA out and try to tube with normal laryngoscopy. But where is the fun in that? Seriously you can continuously ventilate via your LMA with the swivel connector and pass a bougie. Or tubing with the Levitan stylet is quick via the SGA and the SGA itself protects your airway from injury during the intubation.

Comments and questions welcome as always

Minh

 

7 thoughts on “Optical stylet intubations two ways by Master DuCanto

  1. To be honest I’ve been struggling to follow all the different devices and techniques in these vids over the past few posts but those two videos really helped to show how useful they could be. The glidescope and stylet together especially. Great stuff Minh and Jim

    1. thanks Andy. I admit it takes some fanaticism to make sense of the plethora of airway devices available and in general it comes down to personal preference and the training you are exposed to. There is no one size fits all approach to airway management. Jim and I are trying to emphasize safe principles of oxygenation during intubation as well as combining airway techniques to improve success in difficult cases. As I have written before, the single best airway device is the one you carry between your ears.

  2. i’d always been told pre-ox was important but i’d never seen a decent way of doing it in the critically till all this stuff appeared on the web from yourself, Jim and Scott. I imagine that’s just the severe lack of training and experience I have! (it’s hard to get that lots of airway experience here without actually working as a gas man for a few years)

    1. which is why Jim, Scott and I are posting lots of materials and media on emergency airway management! Levitan lead the way well before with publishing the first DVD video of dozens of intubations and laryngoscopies. He actually had the original idea of online airway training. I am doing my best to promote that concept. Scott has actually proof of concept with at least 2 cases of successful surgical cricothyroidotomy reported on his blog from readers of his described technique. I am aware of one successful needle cric by a reader of my described technique. Thats three patients who owe their successful surgical airway to online teaching of the techniques.

      I appreciate learning emergency airway management can be difficult in the UK/Ireland. Come down under and spend a few months getting what you need! Or spend some time with Jim or Scott in their shops!

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