The GlideScope® Ranger – A Unique Case Study
Michael R. Hawkins, MS, CRNA, (CPT, USAR), is a certified registered nurse anesthetist at Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and an instructor in Anesthesia at Dartmouth Medical School. He’s also a captain with the U.S. Army Reserve, 405th Combat Support Hospital, West Hartford, Conn., and was deployed to Iraq in 2005 and 2007–2008. He described his wartime experiences using the GlideScope Ranger for a special supplement to the Journal of Emergency Medical Services.
Unexploded Ordnance Lodged in the Leg
A patient presents with an explosive device embedded in his leg and any movement could trigger it. This was a dilemma faced by the medic of a combat unit in Iraq. His patient was awake and alert, had no airway distress, and minimal bleeding from the entrance wound of the unexploded ordnance (UXO). Once it was determined that there was no emergent surgical need to control bleeding, a plan was carefully devised to remove the UXO from the leg of this patient with minimal movement.
The area around the patient was cleared and secured. A surgeon and anesthetist responded from the CSH to assist the medic in removing the UXO. The team of three carefully removed enough clothing to establish an IV line, all the while cognizant that any movement could trigger the device. The patient required general anesthesia in order to remove the UXO from his leg, and the goal was to perform rapid sequence induction with minimal or no movement. Once the patient had an IV and was placed on oxygen, he was induced with general anesthesia. After the patient was asleep, the Ranger was used to perform the laryngoscopy and secure an ET tube. Once the airway was secured, the surgeon, medic and explosive ordinance team removed the UXO.
The providers later acknowledged that the Ranger was utilized for several reasons: First, "the patient could be intubated exactly in the position found." Second, "the force required to obtain a glottic view is minimal." The goal was to be as gentle as possible. And finally, "it was felt that the Ranger would give the providers the quickest, clearest view of the glottis."
Video laryngoscopy using the Ranger has simplified management of the difficult airway in the combat environment. It has given patient-care providers a compact and durable device to definitively secure ET tubes in complex airways. In addition, it may be the optimal way to secure endotracheal tubes in those patients with suspected cervical-spine injuries or traumatized airways. For EMS systems that struggle to maintain proficiency with ETI, the GlideScope may level the skill requirement enough to increase the overall success rates of ETI by providers who have infrequent intubation experience. http://www.jems.com/article/patient-care/military-experience
The author has received no monetary support from Verathon Inc. His EMS system, U.S. Army, 325th CSH, has received support from Verathon Inc. in the form of a video laryngoscope for evaluation and research purposes.
Military Awards for Verathon
The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense or the U.S. Government.