Tag Archive | "laryngoscope"

Scary Airways

Tags: , , , , , , ,


Overcoming fear is the first step to slaying the dragon of a difficult airway. The next is choosing your tools to face the monster. Photo Chris Swabb

By Jim Radcliffe, BS, MBA, EMT-P

I hope everyone is having a great year. I know the economy is tight and there’s all this political stuff going on in and out of our industry, but that’s not why we got into this business in the first place. Somewhere in our lives, we were bitten by the EMS bug. Some of us really came down with it and we have spent most of our lives serving other people. Believe it or not, I’ve had the honor and privilege of knowing some paramedics and EMT’s in their 80s still serving and teaching, running circles around their younger counterparts.

However, it doesn’t matter how old or young, new to medicine or experienced you are, we all have to understand the anatomy and physiology (A&P). Few have the luxury of going through programs with excellent science programs that mirror what medical school students must learn, so A&P becomes scary. One particularly scary and disorienting area of A&P is the airway. The A&P of the airway is scary for a couple reasons, I know it was to me and still is today—but for different reasons. I would like us to take a few minutes to take a look at the A&P from a couple perspectives and talk about how we might make it a little less scary for everyone.

Bring on the Nightmares
Do you remember when you were a student or a new paramedic and going into the operating room for an airway rotation? How about that first field intubation you did? It was probably in front of your preceptor or field training officer (FTO). Wow, I know it was a couple decades ago for me, but I still remember that my hands were shaking and I was sweating while trying to verbally walk myself through the steps and reviewing the A&P in my head.

I did all this as I attempted to impress the anesthesiologist behind me, whom I had met only an hour before. Then I remember noticing that he was right behind me, and his chin was almost on my shoulder as he was trying to look down my laryngoscope blade to see what I was seeing. I know it sounds like a Steve Berry cartoon, but it’s true. It took me several years and my turn as a preceptor and instructor to understand that intubation is not just scary for the student but also for the preceptors and FTOs.

Over the past several years I’ve learned a couple things I think could really help us conquer this fear of the airway A&P and help us all to be better providers and paramedics. So the first thing we have to do is what my good friend Charlie used to say, “Take a deep breath and relax and think about what’s for lunch.” To be a good provider, you have to know the A&P upside down and backwards (and I like to say so well that you have nightmares about the epiglottis.)

Monsters, Dragons & Beasts—Oh My!
So let’s start at the top and review some basic A&P that we all must know. Air comes into our patient through the nose and the mouth as they breathe or we breathe for them. The air going in through the nose is warm filtered and humidified as it goes over the turbinates lined with cilia to filter out the dust and things floating in the air to keep it out of our airways. That air then proceeds down through the nasal pharynx, connects with the posterior oral airway and goes down to the larynx.

Remember that the oral and nasal passages are separated by the hard and soft pallet. The air going in through the mouth must pass by the teeth and proceed the first monster of the airway, the tongue. Yes it seems like and looks like a monster the first time you attempt to slay the dragon of an airway and you are staring down a laryngoscope blade at that beast. No wonder it’s the largest and most common airway obstruction. After getting passed the tongue there is this strange character that you meet called the uvala. He is just hanging there off of the soft pallet pointing you south toward the darkness of the airway. When the patient is breathing this is like a wind tunnel but when you are marching through here with a little metal stick with a light on the end of it the air is still, stagnate and full of foul odors. As you begin to round the corner to head down to the larynx the uvula reminds you, “watch out for the epiglottis just around the corner.

Oh yes the epiglottis, not quite as large as the tongue but still a monster that’s slippery and illusive. For years, I would intubate by looking for the vocal cords Then one day, I realized that everyone has an epiglottis and it’s always in the same place. Think about it for a minute; pull up that old A&P picture from the recesses of your brain and look at the side view. Yep that’s it. Follow the center of the tongue, the forough, to the base of the tongue. At the base of every tongue is an epiglottis. The landmark between the tongue and the epiglottis is called the vallecula. The epiglottis comes in many sizes depending on the size of the patient and how many Whoppers they consume daily.

Which landmark do you look for most when beginning an intubation?

View Results

Loading ... Loading ...

If you’re intubating, then you most likely have laid the patient flat on their back. (I’m not sure who ever thought to do that, because all the stomach content is now running toward the posterior oral airway and we have to lift all of the structures out of the way.) If you can, place the patient in a low Fowler’s position, it will make your life so much easier and help fix that crook in your neck as well.

Weapons of Choice
If your patient is large, you’ll most likely find a large, floppy epiglottis lying in a pool of slime at the bottom of the posterior oral airway, just waiting to jump up and ruin your day. You’ll need one other weapon in your arsenal to slay this monster, which would be your suction, never leave home without it. It seems that this monster is a lot easier to defeat when you take away his hiding places. Also when you put the patient in a low fowler’s position and put about two inches of padding behind the patient’s head you straighten out the airway and take away the corner’s for the epiglottis to hide. Choosing the correct light stick (laryngyscope blade) is important here, depending on the size of this epiglottis you may need a thin, wide or curved stick to defeat the monster. We will save the choice of weapon for another discussion. Once you defeat these two monsters, entering the cave of the airway dragon is pretty easy from there.

Over the past several years, numerous additions to the EMS airway resources have improved prehospital airway management. One simple change has been the introduction of fiberoptic and LED lighting systems on laryngoscope blades, which has made illuminating the airway much easier.

The introduction of video laryngoscope, which enables users to capitalize on a superior glottic view and access provided by the video image, has significantly changed first attempt success rates When you’re dealing with difficult airways in which you can’t get good line-of-sight visualization, video laryngoscopy uses a camera and a video monitor to visualize the airway and the glottis, enabling faster intubation. It has also given us a huge educational advantage. In teaching settings, the video laryngoscope allows the preceptor or instructor to see what the student or new provider is observing. For the classroom or lab setting, video trainers allow the instructor to walk the student through the airway and discuss issues that are encountered. I have found the use of video laryngoscope in cadaver labs has been extremely helpful to the students. Many video laryngoscopes have a “video out” feature that allows you to push the image to a larger screen for a group to be able to see what the intubator—whether the instructor or another student—is observing.

No More Fear
Over the years teaching in cadaver and airway classes, students will ask why they were never told these things in their initial training. I have found that understanding the A&P, the use of landmarks and the introduction of video laryngoscope has helped to take the scariness out of prehospital airway management. Hope this helps your practice.

Be Safe,
Jim Radcliffe, MBA, BS, EMT-P

Post to Twitter

Airway Finesse

Tags: , , , , , , , , , ,


Visualizing the Airway

Video laryngoscopy uses a camera and a video monitor to visualize the airway and the glottis, enabling faster intubation. Photo James Radcliffe

The ancient Egyptians figured this out when they built the Great Pyramids thousands of years ago. They used tools to work smarter, not harder.

Intubation is the same way; for years I’ve been watching students and experienced providers in labs and in the field do the same exact thing as the guy moving the furniture. The more frustrated they get, the more brute force they apply and the worse the situation gets. It isn’t until they slow down and begin to work smarter that they begin to have success. There are numerous ways that prehospital providers can gain mechanical advantage and optimize our laryngeal view. We have to understand which tools to use for this each patient during each intubation attempt. Choosing the right blade or techniques is important, as is understanding that some patients or situations dictate other options, such as blind-insertion airways or video laryngoscopy. Video laryngoscopy uses a camera and a video monitor to visualize the airway and the glottis, enabling faster intubation when you’re dealing with difficult airways in which you can’t get good line-of-sight visualization.

People have been placing metal sticks in mouths for centuries to examine the oral pharynx, and inventors have been keeping pace by creating a bigger and better device at every turn. But let’s stop and consider what we are really trying to accomplish with direct laryngoscopy.

Four Steps for Direct Laryngoscopy
Step one is to move any obstacles, such as vomit, food or teeth, out of the field of view with good suction. Trying to visualize an airway through all that stuff is like trying to drive 60 mph in a torrential rain storm without windshield wipers. You’re not going to be able to drive in the rain without wipers, and you’re not going to successfully intubate without suction. The suction unit is our best friend when it comes to airway management for EMS (but it seems to be the one piece of equipment that is left in the truck, missing a hose or uncharged, so it often isn’t there when the need arises).Once we clear the airway, then we’re ready to take a look at the airway.

Step two is to get that first look before anything else gets in the airway. The scissor technique allows us to open the mouth of the supine patient so we can get a great look at the posterior oral pharynx. This is where we begin to identify our landmarks and possible obstructions. Looking straight into the mouth, the first thing we see is the tongue. The size of the tongue plays a part in determining which blade we will use for intubation. If we’re able to see past the tongue, we’ll see the uvula lying in the posterior oral pharynx. As we begin looking into the mouth, we consider the proportion of the structures to the overall space. This helps determine the level of difficulty—or as a good friend always says, “how fun” it will be manage the airway. Once we have a good assessment, we’ll have some idea what tools we might want to use.

Which level of difficulty during intubation do you prefer?

View Results

Loading ... Loading ...

Step three is to choose the right tool for the job. Prior even to opening the airway, the experienced provider has already assessed the patient externally to determine the level of difficulty to anticipate and the equipment to use. Several scoring systems out there assess the level of difficulty of an airway. The most common is the Mallampati score, which ranges from 1 to 4 with 1 being the best view and 4 being the worst. Richard Levitan, MD, came up with a great tool that we will refer to as the “Four Ds” for oral tracheal intubation. The Four Ds include distortion, disproportion, dentitions and dysmobility. A good way for a provider to assess the Four Ds is using the 3-3-2 technique, which includes 3 fingers breath between the incisors, 3 fingers from the hyoid bone to the chin and 2 fingers from the floor of the mouth to the top of the thyroid cartilage. The rule of thumb is the fewer the fingers, the straighter the blade. Imagine trying to get a big fat stick in an opening that’s barely wide enough to get the tongue through. Choosing the correct laryngoscope blade will help ensure that our efforts aren’t impeded by the tool.

Do you use the Mallampati scoring system when assessing the level of difficulty of an airway?

View Results

Loading ... Loading ...

Step four is selecting an intubation technique. The direct laryngoscope is a lever with a light at the end of it. Unlike a video laryngoscope, which enables users to capitalize on a superior glottic view and access provided by the video image, direct laryngoscopy doesn’t allow us to look around corners. Therefore, we must have a good understanding of the anatomy to correctly place and use it. The first obstacle that we must move with our lever is the tongue. We simply follow the center of the tongue with tip of the blade and gently lift as we advance, and the blade will naturally come to the vallecula at the base of the tongue. Simply pulling the tongue forward and down will displace the tongue and expose the laryngeal structures; veterinarians have been doing that for years to secure airways in large animals. Remember the laws of physics—every action has an equal and opposite reaction. This means that whatever you do with the handle of the blade will move the other end of the blade. Remember you can’t look around corners so trying to play seesaw or rocking back toward the teeth is only going to impede your view.

Anatomy Refresher

EMS Airway Expert Charlie Eisele shows the airway structures on a cross section of a plasticized cadaver head. Photo James Radcliffe

Relax & Recall Your Anatomy Lessons
Remember to work smarter, not harder. When I teach together with my flight medic friend of mine (the one who grades intubation difficulty in levels of fun), he always says, “Relax. Your most important decision in your shift is what’s for lunch. This will pass.”

So relax and take a deep breath. If you’re one of those folks who needs to take a death grip on the handle and your arm shakes when you intubate, try a pediatric handle and hold it with two fingers and your thumb toward the base of the blade. Great. Now imagine those ancient Egyptians again moving large stones with a lever. They didn’t move it by rocking back; they lifted up and forward. so place the laryngoscope blade at the base of the tongue and lift up and out to move it out of the field of view to visualize the laryngeal structures.

I tried every trick and gadget I could find for years, but they never seemed to work and all I did was get frustrated. I was told if you drop the head of the patient off the end of the stretcher or prop up the shoulders, it would make a better view—wrong. It wasn’t until I started to study the anatomy and consider what I was trying to accomplish that I realized that all I was doing was moving all the structures into my field of view, requiring me to move them even farther to get that good look at the larynx. However, if the patient’s condition will allow, then raise the head to bring the ears even with the chest, thus aligning the axes to allow for a better view.

Success Is As Easy As…
Finding your success is as easy as following this simple rule: Don’t block your view. Keep the blade at an angle to maximize the field of view by sweeping the tongue to the left and slightly turning the handle toward the left. Make sure when inserting the tube to keep the tube to the right side of the mouth, and watch the tip advance through the glottic opening. One technique for advancing the tube is the hook method, simply sliding the tube into the oral cavity from the right corner of the mouth.

If you understand the anatomy and the mechanics of direct laryngoscopy, your success rate will greatly improve. Remember that intubation is a finesse skill, not brute force, so relax and work smarter, not harder.

Be Safe,
Jim Radcliffe, MBA, BS, EMT-P

Post to Twitter

The Effect of Intubation on CPR

Tags: , , , , , , , ,


The debate is ongoing regarding interruption of chest compressions during CPR of cardiac arrest patients in the field. Photo Craig Jackson

Review of: Wang HE, Simeone SJ, Weaver MD, et al. Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Ann of Emerg Med. 2009:54(5):645-652.

The Science
Emergency guidelines have started emphasizing continuous uninterrupted chest compressions for the treatment of cardiac arrests. Traditionally, paramedics in the U.S. almost always perform endotracheal intubation (ETI) on cardiac arrest patients. The authors of this study examined interruptions in chest compressions due to paramedic ETIs using data from the ROC study. They defined an interruption as greater than five seconds. They excluded the period of interruptions related to rhythm analysis. Of 182 arrests, 100 cardiac arrests were analyzed and found. They also found the following:

Median number of interruptions for ETI per cardiac arrest: 2 with a range of 1-9.
Median time for first ETI associated CPR interruption: 46.5 seconds with a range of 7-221 seconds.
Median time for second and subsequent intubations associated CPRF interruption: 35 seconds with a range of 21 to 58 seconds.
Average number of intubation attempts was two2 with a range of 1 to 9
Median total for all endotracheal intubations: 109.5 seconds.
This total interruption time did not change significantly when interruptions where defined as 10 seconds but decreased slightly (102 seconds) when interruptions were defined as 20 seconds.
ETI accounted for 22.8% of all CPR interruptions.

The authors conclude ETI by U.S. paramedics accounts for a significant amount of interruptions, as well as prolonged interruptions.

The Street
The authors find the results of this study on the role of intubation in prehospital airway management of cardiac arrest patients to be eyebrow-raising, but for different reasons.

Medic Marshall: I have to admit that I’m not one to jump to the laryngoscope and ET tube to manage someone’s airway. But I find this research disturbing and appalling. The statistics speak for themselves. I find them staggering. Nine intubations attempts? Or almost four minutes to intubate a patient? This is exactly why I’m a strong proponent for alternative airways, such as the King LT or Combitube. They are faster and more efficient, and can still secure the airway while minimizing interruptions. Best of all though, they can still be used with an impedance threshold device, such as the ResQPOD.

Again I feel the need to re-iterate that I m not against paramedics intubating in the field, just that it is really hard to justify when you have research like this. If your system is capable of giving their providers the experience and education to intubate proficiently, then by all means I think you should; I also think excellent clinical judgment needs to be used as well though know when to tube or not to tube.

Doc Wesley: I congratulate Dr. Wang and his colleagues for providing us even more compelling reasons to not perform ETI in the cardiac arrest victim. Research clearly shows that interruptions in chest compression greater than 10 seconds results in a significant decrease in coronary perfusion. This loss occurs not from the interruption alone but from the fact that it takes at least 30 seconds of chest compression to “re-prime” the heart.

Although many will scoff at the apparently long interruptions and multiple intubation attempts and say, “this could not happen in my system,” to them I say, “you are wrong.” This study was from multiple high-performance systems with excellent medical oversight and quality improvement.

Regions Hospital in St. Paul will soon be publishing their data, which shows that they were able to insert the King LT within one minute of patient contact without chest compression interruptions.

While there may be value for prehospital endotracheal intubation, the evidence is growing daily that for victims of cardiac arrest and multiple trauma, alternative airways used with appropriate monitoring may be more beneficial and avoid significant complications.

The goal now is to further reduce the chest compression interruptions with faster rhythm analysis and defibrillation.

Post to Twitter

Always Protect the Tube

Tags: , ,


Always protect the tube

Post to Twitter

Airway Blessings

Tags: , ,


Gesundheit!

Post to Twitter

The Video Laryngoscopy Movement

Tags: , , , , , , , ,


By John Allen Pacey, MD, FRCSc

In 1829, the first known device for direct laryngoscopy was invented by British physician Benjamin Guy Babington. Later, the work of the widely recognized father of laryngology, Manuel Garcia, led to the first mirror laryngoscope prior to 1849, with a light source later introduced by Alfred Kirstein in 1895.(1)

In the century since then, the devices available to view the larynx have gone through many evolutions. Most devices have been difficult to use, and injuries related to failed or delayed tracheal intubation have resulted. Recognizing that optimal airway management involves the direct visualization of the airway during intubation, modern direct laryngoscopy has produced different blade lengths, prisms and fiber-optic light channels. However, the emergence of video capabilities in the surgical suite was perhaps the most significant step in laryngoscopy development.

Video laryngoscopy systems provide a clear picture of the larynx and vocal cords on a display monitor, enabling control of the endotracheal tube (ETT) in its trajectory toward the airway. This type of clearly displayed view facilitates fast, accurate ETT placement in difficult airways, preventing complications resulting from improper tube placement.

Other advantages of video laryngoscopy compared with older, fiber-optic systems are substantial. Video images are easily stored on servers and low-cost SD cards, and can be transmitted to other users, allowing for remote recording of activity, skills coaching and quality assurance reviews. The use of Internet display is easy either with real-time transmission or by display of the captured images, so that the captured sequences can be used for teaching purposes to improve the skills of many. As HDTV technology improves, so will the image quality of video laryngoscopy. Last, video laryngoscopic techniques are easier to master than those necessary for direct laryngoscopy, an important factor in its successful use by personnel working in less-than-optimal circumstances.

Initial advocates of video laryngoscopy were anesthesiologists in Vancouver, Canada, who performed intubations daily. Such luminaries as Richard Cooper, BSc, MSc, MD, FRCPC; John Doyle, MD, PhD; and Ron Walls, MD, raised questions about the viability of direct laryngoscopy compared with video laryngoscopy and sponsored the adoption of the technology in other areas of the hospital, such as the emergency department (ED) and the ICU. While recognizing the expense of adding the video component, Cooper in particular has commented that video laryngoscopes are “more robust and resistant to damage.”(2) Adoption in EDs and ICUs has been rapid, and it seemed only a matter of time until video laryngoscopy was introduced into prehospital medicine.

The Need in the Field
The literature shows that intubation performed in an out-of-hospital emergency environment carries with it a higher rate of complications and death.(3) Rapid sequence intubation (RSI), called for by Rosen and others, initially appeared to be effective when coupled with direct laryngoscopy (97% in some reports).(4) But optimism dissipated when a 2003 San Diego study reported that 45% of “easy” or successful intubations carried out on head-injured patients were associated with hypoxemia or bradycardia.(5)

In pediatric patients, the literature shows a need for improved methods. A 2000 San Diego study of 305 pediatric patients showed a success rate of 57%, esophageal intubation of 2% and displaced ETT of 15%.6 An older study, from 1989, reported a 50% success rate in children one year in age or younger.(7)

The reasons for these failure rates are obvious to anyone who has worked in the field: the variable intubation skill levels among EMS personnel and adverse conditions, such as weather, limited lighting, foreign bodies in the airway and trauma (leading to hemorrhage and distorted anatomy). Because direct laryngoscopy in these conditions continues to be fraught with difficulty, EMS medical directors are reconsidering their airway management protocols. Although it’s clear some EMS personnel are able to overcome the deficiencies of direct laryngoscopy and produce acceptable results, the failure rates have provoked questions of whether direct laryngoscopy has become a “legacy technique,” introduced when there were no alternatives.(8)

GlideScope in Use
In 2001, the GlideScope® was introduced as the first commercially available video laryngoscope. The device was designed with the recognition that a camera positioned away from the tip of the device would provide the best perspective and enhance visualization. The 60º angle allows for 99% Grade 1 and 2 views.2 Another significant design feature is the device’s unique anti-fog component, which reduces lens contamination.

The GlideScope Ranger single-use laryngoscope—designed to eliminate the need for disinfecting the blade for fast-paced intubation settings—is being used in Iraq and Afghanistan. The backpack-sized, rugged and shockproof version of the original device with an antiglare screen was trialed at the R. Adams Cowley Shock Trauma Center, Fort Sam Houston and Andrews Air Force Base. Following successful trials of the device at these world-renowned medical facilities, the Ranger was deployed in hospitals and combat settings.

In particular, a number of reports from the Canadian Expeditionary Hospital in Kandahar, Afghanistan, involve the management of bloody airways, intubation around expanding hematomas and other challenging ETT exchanges. The Ranger is also in trials with Whatcom County (Wash.) EMS, where the early results are encouraging, according to Medical Director Marvin Wayne, MD.

Aeromedical applications, notably in helicopter environments, are also under study with the GlideScope Ranger. It’s notable that first-time aeromedical users had a high success rate even in the most adverse conditions. Reports of Ranger intubation under unusual conditions include two intubations prior to extrication from crushed vehicles, in flight re-intubation, and in-flight primary intubation (where direct laryngoscope use is limited).

A Look Forward
There’s considerable pressure on EMS to improve successful intubation rates, and the advent of video laryngoscopy designed for the field is poised to produce findings that support its use in this demanding context. How extensive a role this technology will play is complicated by the debate over whether intubation—considered the gold standard in anesthesia practice—is necessary for all compromised airways. EMS personnel work with patients who are often treated under adverse conditions, and there will always be a need for difficult airway management in the trauma setting. A growing amount of evidence supports the view that video laryngoscopy will be a standard in that setting, but more studies are needed before it’s an established reality.

As for speculation about the future of video laryngoscopy in the prehospital setting, aeromedical studies will likely continue to demonstrate the efficacy of RSI using video laryngoscopy. It’s felt that “time on the ground” can be significantly reduced by the use of video laryngoscopy-assisted RSI, either pre-flight or in-flight. Also, many feel RSI coupled with video laryngoscopy will be shown as the most effective strategy for prehospital intubation management, which will likely involve development of supraglottic airway technology.

The cost of failed or difficult intubation can be very high as reflected in a private settlement in excess of $15 million in 2002.(9) There’s also the cost associated with emotional burden to the providers involved, who may face insurmountable obstacles to care.

The added value of video recording will allow medical directors to more accurately measure personnel competency and skill success rates, document the depth of ETT insertion and enhance education. Overall, these devices can aid emergency airway management and likely lead to better patient care—a universal goal of all EMS providers.

References
1. Proceedings of the Royal Society of London. vii:399–410, 1856.
2. Cooper RM, Pacey JA, Bishop MJ, et al: “Early clinical experience with a new video laryngoscope (GlideScope) in 728 patients.” Canadian Journal of Anaesthesia. 52(2):191–198, 2005.
3. Murray JA, Demetriades D, Berne TV, et al: “Prehospital intubation in patients with severe head injury.” Journal of Trauma. 49(6):1065–1070.
4. Bulger EM, Copass MK, Maier RV, et al: “An analysis of advanced prehospital airway management.” Journal of Emergency Medicine. 23(2):183–189, 2002.
5. Dunford JV, Davis DP, Ochs M, et al: “Incidence of transient hypoxia and pulse rate reactivity during paramedic rapid sequence intubation.” Annals of Emergency Medicine. 42(6):721–728, 2003.
6. Gausche M, Lewis RJ, Stratton SJ, et al: “Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: A controlled clinical trial.” JAMA. 283(6):783–790, 2000.
7. Aijian P, Tsai A, Knopp R, et al: “Endotracheal intubation of pediatric patients by paramedics.” Annals of Emergency Medicine. 18(5):489–494, 1989.
8. Cooper RM: “Is direct laryngoscopy obsolete?” Internet Journal of Airway Manage­ment. Vol. 4, 2006–2007. www.adair.at/ijam/volume04/specialcomment01/default.htm
9. Law Offices of Wade E. Byrd, P.A. 232 Person St. Fayetteville, NC 28301.

Disclosure: The author is the inventor of the GlideScope, and president and research director for Verathon Medical Canada, the makers of GlideScope systems.

This article originally appeared in The Perfect View.

Post to Twitter


EMS Airway Clinic is a new site offering best practices in airway management and education for EMS professionals and educators, featuring:
  • • Regular articles by Charlie Eisele, Flight Paramedic, retired First Sergeant with the Maryland State Police Aviation Command, and co-founder of the Advanced Airway Course at EMS Today
  • • Case studies, how-to videos and podcasts
  • • The "Airway Funnies" from popular EMS cartoonist Steve Berry
  • • The latest news, features and educational content on prehospital airway management
  • Learn more about EMS Airway Clinic

    Like Us on Facebook

    Featured Airway Products

    Providing emergency patient care on the ground or in the air is complex and challenging. That's why the tools used by paramedics and EMTs must be adaptable in a constantly changing clinical situation — quickly operational, rugged and easy to use. Learn more about EMS airway management.

    GlideScope Ranger

    The GlideScope Ranger video laryngoscope delivers consistently clear airway views enabling faster intubations in EMS settings. Available in reusable or single-use configurations.

    See more products …

    GlideScope Cobalt AVL

    GlideScope Cobalt AVL

    The GlideScope Cobalt AVL video laryngoscope offers airway views in DVD-clarity, along with real-time recording. On its own or when combined with the GlideScope Direct intubation trainer, the Cobalt AVL is an ideal tool to facilitate instruction of laryngoscopy.

    See more products …

    GlideScope AVL Reusable

    GlideScope Cobalt AVL

    The GlideScope AVL Reusable video laryngoscope offers airway views in DVD-clarity, along with real-time recording. On its own or when combined with the GlideScope Direct intubation trainer, the AVL is an ideal tool to facilitate instruction of laryngoscopy.

    See more products …

    Featuring Recent Posts WordPress Widget development by YD