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DL versus VL – The Laryngoscopy Wars

Hey, it’s a partisan world out there, and change isn’t always easy. But whatever your position is on video laryngoscopy (VL) versus direct laryngoscopy (DL), everyone agrees that VL tools are now an integral part of the airway management landscape, and while VL may not have killed DL as many proclaim, it has at least given DL a good reason to worry for its survival in the coming years.

An Overview

The entire history of laryngoscopy and successful endotracheal intubation can be summed up as an endeavor to develop tools that overcome the anatomical obstacles and angles that prohibit a clear view of laryngeal structures.

In direct laryngoscopy success depends on lifting or sweeping structures such as the tongue out of the way, and positioning yourself and the patient is such a way as to allow for a direct line of sight to the epiglottis and the vocal cords. The flaw in this system is that it still requires physically overcoming anatomical structures and angles that are not always easy to overcome in all patients.

Video laryngoscopy takes all those issues away by placing a camera at the end of your intubating equipment. You no longer have a direct line of sight, but what you get in return is usually a beautiful view of the cords on a screen or heads-up display that (with a little practice) can be used to guide placement of an endotracheal tube. The flaw in this system is that by taking away your direct line of sight you become even more dependent on another layer of technology, and the evidence that it makes first pass intubation more successful is still up for debate.

Review the differences

This short video by Reuben Strayer  is the best brief explanation of the two approaches and will give you a working knowledge of the differences.  I highly recommend it.

Flipping the Airway – Tools of the VL Trade

The success of VL has led to a proliferation of companies competing for your business, all with VL tools of different sizes and shapes.  In the DL-only times there was just the MAC and the Mimg_0455iller, now there is the Glidescope, the KingVision, the C-Mac, the Pentax, the McGrath… (you get the idea), each requiring a slightly different hand/eye skill set. There are also some basic concepts in VL that are universal you should be aware of before you pick up your first VL tool.

To help, we’ve created a curated bundle on all things VL using our Flipboard Magazine platform. Here you can find instructional videos on many of the VL products out there, videos of actual VL intubations using these tools, all mixed in with some essential pearls and pitfalls of using VL, and a healthy dose of entertaining VL-related posts from assorted social media. You can find it all here at the  Protected Airway’s Flipboard Magazine .

The EMBER – For a Different Perspective Check Out These

Bundled Resources & Reviews from around the FOAM universe

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