We’re using it and it’s pretty cool. We thought at first it’d be a rescue thing, but nearly everyone is using it primarily, and I am one of them. Once you get the hang of it, it’s a snap. Much less force, and easy learning curve. Caveats: lots of secretions/stomach contents can make it very hard to see, and you really need to turn the lights off in the room to see the screen well. I also had a really obese pt where the soft tissues blocked the view. She must have had horrible sleep apnea. I ended up just lifting it up and intubating like I would with a Mac blade. Overall, I love it. I’ve heard that Harvard (Ron Walls, Airway Course guru, is the chair) uses it primarily as well, but may just be a rumor. Contact me directly if you want more info.
We use it too. It’s a new gadget for us and I’m just getting comfortable with it. But it’s way cool and probably a great tool to have in your difficult airway kit.
we’ve got one in each of our trauma bays, and up in the OR’s.
it’s a nifty gadget that’s not too hard to use when you get used to using it (it’s got some monstrous curve that you have to get in just right before you see the cords).
i still do most of my intubations the old fashioned way with a 3/4 Mac, because I know not everywhere I go will have the glidescope. when we get someone who’s collared that we need to tube, i’ll use the glidescope.
I love the glidescope. The curve is the trickiest part. You need a good hockey stick on your tube or you get hung on the arytenoids. A great tip I picked up from a gas guy is to get the tube in line with the cords and slide it off of the stylet (with someone else holding the stylet) and the hockey stick forces the tube up and thru the cords. Used that technique 2 days ago and it was money. Steve
Few of the patients appear to have been intubated using paralytics. The final patient, case C13, had no ventilation from 04:40 to at least 06:15, unless there is an edit that I missed. The patient also seemed to be experiencing laryngospasm, which was causing some problems for the intubator.
In the video, the views looked great, but a couple of the patients were intubated without actually visualizing the vocal cords. Nothing wrong with that at all, just surprising in a video supposed to demonstrate an improved view.
It is nice to see that others do not feel that a view of the vocal cords is essential to intubation.
I love the glidescope. It is my go to method whenever I have a patient with a difficult airway. My trick is to put the stylet in the tube and make sure its curve matches the curve of the blade. It’s hard to use if the patient has a small mouth opening. Once I have the tube lined up in the opening, I slide the tube forward without the stylet (it helps if you lube the stylet). The best advantage for me, is that I don’t have to manipulate the neck to intubate someone with this. I’ve actually intubated c-spine patients without removing any part of the c-collar. One caveat is that sometimes, despite having a terrific view, it can still be hard to angle the tube into place (especially if they have a really anterior airway).
You can get reusable stylets that match the curve of the Glidescope. They are rigid, and it takes a bit of getting used to because you can’t slide the tube fully through the cords without removing the stylet. There’s a flange for your thumb to pull the stylet back a bit, then you push it a bit further, take out the stylet, and advance the tube fully. It’s not hard once you get the hang of it, and sure as hell beats molding your own stylet every time. As I said before, I like it primarily rather than simply as a rescue approach. Intubating with the standard laryngoscope ain’t rocket science, and I have no worries that my skill will atrophy. Especially with the patients you know will be a difficult intubation, the Glidescope has reduced the adrenaline level hugely. That’s stress I can do without.
As a future med student working as an assistant in the OR, I think it’s pretty damned cool. It seems like it’s a bit easier to use with patients who have more difficult airways, instead of grabbing the Bullard, which seems more cumbersome. It also lets other people assisting you know whether you need cricoid pressure, BURP or anything else without asking for it. To me, it seems like it makes the process a lot faster and smoother. Like they’ve said above, serious curve and you’re good to go.
We have one too. I used it once on an easy case just to try it out and it was pretty cool. I did see anaethesia use one with a really hard intubation – they failed. The airway was too edematous so it was not really the fault of the scope. The guy wound up getting a trach.
Our Docs adore the glidescope.One particularly avid MD fan jealouly guards it and insists on accompanying the glidesope should it be lent to another department.
I’ve used one during my clinicals and thought it was great. There are a few other, less bulky options out their too. I’d have to dig up some resources to link to the ones I’ve tried.
Used it all the time in residency. Best thing ever. Convinced my group to get it and will be very excited to reunite with my friend Mr. G once I return from maternity leave.
Our ER is going to “steal” ours. We’ve used it successfully on several occasions. Use the “four-step” visualization sequence to prevent “blind” injury to mouth and pharyngeal structures. Look in the mouth to introduce the blade. Look at the scope to acquire glottic view. Look in the mouth while introducing the styletted tube. Look at the screen to introduce the tube into the glottis. Stop advancing the stylet at the glottis; push the tube off the stylet like you would push an IV catheter off the metal needle into a vein, while holding the stylet steady.
A conventional malleable stylet is fine as long as the curve is correct. Play with this on the intubating mannequin and the right curve will be self-evident to you.
An LTA doesn’t always work; hard to make the angle. Try the long MAD atomizer to spray the cords and through the glottis if you’re so inclined.
Be sure to turn the unit on a bit before you insert the scope so as to get the full benefit of the anti-fogging mechanism.
If a patient is obese, use positioning wedge or blankets.
It’s tricky to introduce the blade if the patient has redundant breast tissue or if other obstruction to the path of the handle is present. It takes finesse and two hands — a Safar maneuver can be helpful. Just remember to keep inline stabilization on if you’re doing a trauma code.
If the disposable portion of the Glidescope was, let’s say, under $10.00 each. Would you think that this could become an “industry standard” for daily intubation?
We started with the Glidescope as back-up device because 1 member of our staff demanded it. Now, we have 4 and people fight over it. We purchased the disposable system for around $11K I think and the pieces are $15 each. From what I hear, the Glidescope is already an industry standard. They are even starting to assist with field intubations with their “mini” Glidescope (Ranger). Of the 4 systems, we have 1 of them is a Ranger for codes.
May 12, 2008 at 12:58 am
We’re using it and it’s pretty cool. We thought at first it’d be a rescue thing, but nearly everyone is using it primarily, and I am one of them. Once you get the hang of it, it’s a snap. Much less force, and easy learning curve. Caveats: lots of secretions/stomach contents can make it very hard to see, and you really need to turn the lights off in the room to see the screen well. I also had a really obese pt where the soft tissues blocked the view. She must have had horrible sleep apnea. I ended up just lifting it up and intubating like I would with a Mac blade. Overall, I love it. I’ve heard that Harvard (Ron Walls, Airway Course guru, is the chair) uses it primarily as well, but may just be a rumor. Contact me directly if you want more info.
May 12, 2008 at 1:22 am
We use it too. It’s a new gadget for us and I’m just getting comfortable with it. But it’s way cool and probably a great tool to have in your difficult airway kit.
Pricey, but worth it.
May 12, 2008 at 7:32 am
we’ve got one in each of our trauma bays, and up in the OR’s.
it’s a nifty gadget that’s not too hard to use when you get used to using it (it’s got some monstrous curve that you have to get in just right before you see the cords).
i still do most of my intubations the old fashioned way with a 3/4 Mac, because I know not everywhere I go will have the glidescope. when we get someone who’s collared that we need to tube, i’ll use the glidescope.
May 12, 2008 at 9:37 am
I love the glidescope. The curve is the trickiest part. You need a good hockey stick on your tube or you get hung on the arytenoids. A great tip I picked up from a gas guy is to get the tube in line with the cords and slide it off of the stylet (with someone else holding the stylet) and the hockey stick forces the tube up and thru the cords. Used that technique 2 days ago and it was money. Steve
May 12, 2008 at 3:07 pm
I have not used this.
It is an interesting video.
Few of the patients appear to have been intubated using paralytics. The final patient, case C13, had no ventilation from 04:40 to at least 06:15, unless there is an edit that I missed. The patient also seemed to be experiencing laryngospasm, which was causing some problems for the intubator.
In the video, the views looked great, but a couple of the patients were intubated without actually visualizing the vocal cords. Nothing wrong with that at all, just surprising in a video supposed to demonstrate an improved view.
It is nice to see that others do not feel that a view of the vocal cords is essential to intubation.
May 12, 2008 at 7:35 pm
I love the glidescope. It is my go to method whenever I have a patient with a difficult airway. My trick is to put the stylet in the tube and make sure its curve matches the curve of the blade. It’s hard to use if the patient has a small mouth opening. Once I have the tube lined up in the opening, I slide the tube forward without the stylet (it helps if you lube the stylet). The best advantage for me, is that I don’t have to manipulate the neck to intubate someone with this. I’ve actually intubated c-spine patients without removing any part of the c-collar. One caveat is that sometimes, despite having a terrific view, it can still be hard to angle the tube into place (especially if they have a really anterior airway).
May 12, 2008 at 8:35 pm
You can get reusable stylets that match the curve of the Glidescope. They are rigid, and it takes a bit of getting used to because you can’t slide the tube fully through the cords without removing the stylet. There’s a flange for your thumb to pull the stylet back a bit, then you push it a bit further, take out the stylet, and advance the tube fully. It’s not hard once you get the hang of it, and sure as hell beats molding your own stylet every time. As I said before, I like it primarily rather than simply as a rescue approach. Intubating with the standard laryngoscope ain’t rocket science, and I have no worries that my skill will atrophy. Especially with the patients you know will be a difficult intubation, the Glidescope has reduced the adrenaline level hugely. That’s stress I can do without.
May 13, 2008 at 4:19 am
As a future med student working as an assistant in the OR, I think it’s pretty damned cool. It seems like it’s a bit easier to use with patients who have more difficult airways, instead of grabbing the Bullard, which seems more cumbersome. It also lets other people assisting you know whether you need cricoid pressure, BURP or anything else without asking for it. To me, it seems like it makes the process a lot faster and smoother. Like they’ve said above, serious curve and you’re good to go.
May 14, 2008 at 9:09 am
Family Med resident spending lots of time in anaesthesia and ED:
As a learning tool I think it’s great. Easy intubations, great views of anatomy. You’ll be fighting over them as a toy.
That said, most people use it as a backup method.
May 14, 2008 at 8:02 pm
We have one too. I used it once on an easy case just to try it out and it was pretty cool. I did see anaethesia use one with a really hard intubation – they failed. The airway was too edematous so it was not really the fault of the scope. The guy wound up getting a trach.
May 19, 2008 at 1:10 pm
Our Docs adore the glidescope.One particularly avid MD fan jealouly guards it and insists on accompanying the glidesope should it be lent to another department.
May 27, 2008 at 4:17 pm
I’ve used one during my clinicals and thought it was great. There are a few other, less bulky options out their too. I’d have to dig up some resources to link to the ones I’ve tried.
June 2, 2008 at 4:37 pm
Used it all the time in residency. Best thing ever. Convinced my group to get it and will be very excited to reunite with my friend Mr. G once I return from maternity leave.
P.S. Hi 10/10. It’s been a long time.
November 5, 2008 at 12:23 am
Our ER is going to “steal” ours. We’ve used it successfully on several occasions. Use the “four-step” visualization sequence to prevent “blind” injury to mouth and pharyngeal structures. Look in the mouth to introduce the blade. Look at the scope to acquire glottic view. Look in the mouth while introducing the styletted tube. Look at the screen to introduce the tube into the glottis. Stop advancing the stylet at the glottis; push the tube off the stylet like you would push an IV catheter off the metal needle into a vein, while holding the stylet steady.
A conventional malleable stylet is fine as long as the curve is correct. Play with this on the intubating mannequin and the right curve will be self-evident to you.
An LTA doesn’t always work; hard to make the angle. Try the long MAD atomizer to spray the cords and through the glottis if you’re so inclined.
Be sure to turn the unit on a bit before you insert the scope so as to get the full benefit of the anti-fogging mechanism.
If a patient is obese, use positioning wedge or blankets.
It’s tricky to introduce the blade if the patient has redundant breast tissue or if other obstruction to the path of the handle is present. It takes finesse and two hands — a Safar maneuver can be helpful. Just remember to keep inline stabilization on if you’re doing a trauma code.
This thing will save lives, believe me.
Jim
December 19, 2008 at 8:54 pm
If the disposable portion of the Glidescope was, let’s say, under $10.00 each. Would you think that this could become an “industry standard” for daily intubation?
February 6, 2009 at 8:22 am
We started with the Glidescope as back-up device because 1 member of our staff demanded it. Now, we have 4 and people fight over it. We purchased the disposable system for around $11K I think and the pieces are $15 each. From what I hear, the Glidescope is already an industry standard. They are even starting to assist with field intubations with their “mini” Glidescope (Ranger). Of the 4 systems, we have 1 of them is a Ranger for codes.
So, price aside… we won’t ever be without it.