Traditional teaching of direct laryngoscopy involves practice on a training manikin and reference to line
drawings of anatomic landmarks. The inherently difficult aspect of learning direct laryngoscopy is that the procedure is visually analogous to looking down a narrow pipe at a target the size of a quarter. The opening of the mouth, the tongue, epiglottis, and laryngoscope blade all interact to restrict visualization of the larynx to the dominant pupil. The monocularity of laryngoscopy means that the procedure cannot be effectively observed over someone else’s shoulder. A supervisor cannot provide targeted feedback to a trainee because they both cannot simultaneously visualize the laryngeal structures.
The Airway Cam Direct Laryngoscopy Video System, invented by Richard Levitan in 1994, aligns a miniature video camera with the dominant pupil using a beam-splitting penta-prism wedge assembly.
This patented imaging system allows routine imaging of laryngoscopy from the operator’s perspective.
Over a ten-year period, with the help of Michael Higgins (Vanderbilt University) Scott Cook-Sather (Children’s Hospital of Philadelphia), Andrew Ochroch (University of Pennsylvania), and Bill Kinkle, Dr. Levitan produced four videotapes (now available on DVD) that include a total of 65 laryngoscopy cases. The tapes cover adults and children, demonstrating the subtleties of laryngoscopy, using different blades, and highlighting a wide variety of teaching points. The videos were originally produced to VHS videotapes, and are now available on DVD.
These videos have been widely acclaimed by leading journals in emergency medicine, anesthesiology and emergency services.
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This twenty-six minute videotape is fast paced, with professional editing, graphics and narration. This 26 minute video provides an introductory overview to direct laryngoscopy, and demonstrates practical techniques and different blades on a variety of adult and pediatric patients. The dynamic footage shows thirteen different patients being intubated, including a neonate and three additional pediatric patients.
Volume 2 highlights differences in pediatric anatomy and equipment in a seven minute introduction, followed by intubations on a variety of infants and children with different blades. Freeze frames, arrows, and graphics highlight key landmarks and teaching points.
Adult Intubation, Advanced Airway Imaging and Laryngoscopy Techniques
Volume 3 features advanced airway imaging and laryngoscopy techniques. This dynamic tape provides an in-depth look at airway anatomy and intubation. At the start of the tape, fiberoptic and stroboscopic devices display dynamic airway anatomy. A detailed discussion of laryngeal landmarks is presented for a better understanding of what is seen during direct laryngoscopy. After a review of different blade designs, simple and effective laryngoscopy maneuvers are discussed and demonstrated. Intubations are effectively demonstrated on 15 adult patients in approximately 28 minutes.
Secrets of Curved Blade Laryngoscopy
Volume 4 focuses on the secrets of curved blade laryngoscopy. Curved blades are the mainstay of emergency airway management. This tape highlights four major teaching points: the importance of an epiglottis first approach, bimanual laryngoscopy (external laryngeal manipulation by the laryngoscopist), recognition of the posterior laryngeal structures, and straight to cuff stylet shaping. More than twenty new curved blade cases are presented, showing cases from the operating room, the cadaver lab, and the emergency department. In addition to Airway Cam views, anatomy is reviewed using the Glidescope Video Laryngoscope. Custom designed graphics and unique educational methods with non-embalmed cadavers are presented. The overall goal is to present a step-wise strategy for first pass intubation success. Emphasis is also placed on distinguishing the esophagus from the larynx and avoiding pitfalls that can result in esophageal placement.