PHARM PODCAST 104 : VL vs DL with Levitan and Strayer


Image from Twitter. No financial disclosures

Image from Twitter. No financial disclosures

Hi Folks

On today’s show, Dr Richard Levitan and Dr Reuben Strayer debate and discuss the topic of Video Laryngoscopy vs Traditional Direct laryngoscopy.

Prediction is that in 2020, we will all be using BOTH! I still believe VL is a luxury, not a necessity but I do admit it has a definite role and is here to stay.

Listen up folks!

Check out this great educational video from Dr Larry Mellick in regard to pitfalls of VL.


Now, onto the PODCAST!


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Filed under: airway, Emergency medicine and critical care, FOAMEd, Interviews of interesting people, prehospital and retrieval medicine podcast Tagged: DL, itunes, reuben-strayer, Richard-Levitan, VL

Digitally enhanced airway management

CUT symbol - letters made up of bougie, finger and scalpel

CUT symbol – letters made up of bougie, finger and scalpel

Scott Weingart’s surgical airway talk from SMACCGOLD has just been release. PLease check out on this site or at ICN

It got me thinking about the importance of the finger in key rescue airway techniques.

There is the old technique of digital intubation, taught to me by an ex military South African special forces doctor. In fact this has rescued a prehospital airway on at least one occasion I am aware of!

Check out Chris Bonds article on digital intubation here.

It made me think how many airway disasters I knew that a digital intubation was never attempted? I can think of at least 3 well known cases to me! My point is we all seem keen on the latest videolaryngoscope , even when on our hands we carry the tools to do a rescue airway technique that requires no vision and yet if done right can almost certainly rescue the worst failed visual intubation attempt.

Then the surgical airway technique described by Scott, reminded me once again that the finger and digital palpation is the most important element of success of the surgical airway. There are so many ways described in textbooks and courses about how to do the surgical airway and very few stress the importance of using your finger to reliably locate crucial landmarks.

This was reinforced when I was at Sydney HEMS recently and the technique they currently teach is what Scott has described.

Scalpel-finger-bougie technique for surgical airway GSA HEMS style

Scalpel-finger-bougie technique for surgical airway GSA HEMS style

They have learnt through experience and testing that surgical tools like hooks and tracheal dilators in the hands of non surgeons are just too UNRELIABLE. Even when combined with a bougie, I am aware of at least 5 cases of failed scalpel bougie cricothyroidotomy which failed as a finger was NOT used to reliably determine the tracheal lumen.


So really when you think about failed DL and VL, patient is desaturating..LMA is failing. The finger then can help you out 2 ways! Digital intubation attempt or to do a surgical airway! And it costs nothing too!

Now anyone who is a Bruce Lee Fan will recall this famous line from Enter the Dragon “It is like a finger pointing at the moon..”


Filed under: airway, Emergency anaesthesia, Emergency medicine and critical care, FOAMEd, Online critical airway training Tagged: airway, digital, finger, management

Why the VideoLarygoscopy don’t gonna kill the DirectLaryngoscopy (at least in the near future)

Originally posted on MEDEST:

A novel publication goes to enrich the long-living debate on direct laryngoscopy (DL) vs video laryngoscopy (VL) efficacy in emergency intubation.

The recent article, pubblished on JEMS and titled  “Deploying the Video Laryngoscope into a Ground EMS System” ,compares the success rate beetwen DL vs VL in a ground EMS Service. The device used was the King Vision with channeled blade. The partecipants had a prior training on the divide, consisting in didactic orientation and practical skills on manikins.

The result of the study shown that “Within the first 100 days of the study, the video laryngoscope utilizing the channeled blade has shown to be at least as effective as DL in relation to first-attempt success” and considering that “the mean experience in our group with DL is nine years, yet the success rate remains unacceptable” “It’s time to consider transition from a skill that’s difficult to obtain and maintain…

View original 451 more words

Filed under: Uncategorized