McGRATH MAC EMS Instructors Guide Rev A

Contents How to use this guide... 1 Device design... 5 Power... 9 How to use... 11 Difficult airways... 15 Out of hospital confirmation of correct ET tube placement... 21 Decontamination... 23 Troubleshooting... 25 References... 27

How To Use This Guide

How to use this guide The McGRATH® MAC EMS Video Laryngoscope (VL) is easy to use and enables clinicians to achieve direct and indirect laryngoscopy where required. It is based on the familiar design of the Macintosh blade and therefore enables clinicians to effectively secure patent airways, even in difficult to intubate patients. With this comprehensive guide, you’ll be able to train your staff to effectively use the device. This instructor guide is an introduction to the basic operation of the McGRATH® MAC EMS Video Laryngoscope. It does not suggest protocols or policies regarding the use of the Video Laryngoscope. Refer to the Operating Instructions for complete directions for use, indications, contraindications, warnings, precautions and potential adverse events. Moving, removing, highlighting and adding content to this outline to meet individual user needs is encouraged. Hands-on practice and application with scenarios promote learning retention.

Training Tips This guide is divided into seven sections: • Device design • Power • How to use • Difficult airways • Out of hospital confirmation of correct ET tube placement • Decontamination • Troubleshooting All sections are optimally taught in a hands-on format. Instructors should first demonstrate how to use the McGRATH® MAC EMS Video Laryngoscope and then have students practice. Ideally, students will receive enough practice and coaching from the instructor to ensure they can use the device with confidence in an emergency.

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Learning Objectives The overall objective of this in-service is to provide an overview of the basic steps of operation of the McGRATH® MAC EMS Video Laryngoscope. Upon completion of this course, participants will be able to: • Verbalize the importance of endotracheal intubation • Understand basic anatomy of the airway • Explain the rationale behind video laryngoscopy • Demonstrate proficient VL • Demonstrate how to change the battery • Verbalize how to confirm and document correct ET tube placement • Demonstrate device cleaning

Equipment and Materials The following is a list of accessories and support material recommended for training on the McGRATH® MAC EMS Video Laryngoscope. It is essential that all equipment be inspected and tested to ensure proper function prior to training according to the Basic Orientation section of the Operating Instructions.

Equipment • McGRATH® MAC EMS Video Laryngoscope • A suitable head/neck manikin

Accessories • A selection of blade sizes (2, 3, 4 and X) • Bougie • Stylet • A selection of ET tubes • Catheter mount • Thomas tube holder • Magill forceps • 50 ml syringe 2 | McGRATH® MAC EMS Video Laryngoscope

• Suction device • Stethoscope • OP airway • Capnography filterlines • Bag Valve Mask

Support Materials • Quick Start Guide • Operator Checklist • CGI Training Video • Suggestions for User Performance Evaluation Endotracheal Intubation (ETI) is the gold standard for securing a patient’s airway. It is one of the most important skills Paramedics perform. However, it is an infrequently used skill; approximately 2% of EMS calls require advanced airway intervention1. ETI is relatively straightforward; however some patients are difficult to intubate: ETI success rate: Prehospital

77.0–86.3%1,2,3

Hospital:

97.0–99.3%1

Some patients have anatomically difficult airways to intubate. Additional patient-specific factors can obscure visualization in prehospital environment (e.g., anterior larynx, airway swelling due to anaphylaxis, blood, vomit, secretions, trauma, limited cervical mobility) Scene-specific factors can also complicate intubation (e.g., poor lighting, inaccessible patient position etc.) Many paramedics don’t intubate frequently enough to maintain proficiency. There is an element of muscle memory involved, particularly with Macintosh blades. Finesse comes with practice. It takes 20–25 intubations in order to achieve a success rate above 90%, but U.S. national standards only require 5 at graduation.4 Many paramedics perform fewer than 8 intubations per year-some will not intubate for several years.

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Which patients are candidates for Video Laryngoscope? Video Laryngoscope is ideal for patients in cardiac arrest, respiratory arrest and for those that require rapid sequence intubation. In the latter, it is important to intubate swiftly and successfully once a patient has been paralyzed. Diggs, et al – 2012 NEMSIS data: Overall ETI success of 85.3%; RSI success rate of 93.1%1 Wang, et al – 2008 NEMSIS data: Overall ETI success of 77.0%; RSI success rate of 84.1%2 Specific focus on successful intubation in prehospital RSI Video Laryngoscope improves visualization of key anatomic structures compared to direct laryngoscopy 5,6,7,8 Furthermore, it enable providers to see parts of the anatomy that are hidden to the naked, effectively “seeing further around the corner”

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Part I: Device Design

Device design Built-in video and vertical display 2.5” LCD monitor displays a clear view of the vocal cords and laryngeal inlet for an improved anatomical view. Vertically aligned optics displan an earlier visualization of the tube to address tube-induced trauma.

Portable and easy to use Easy to use “switch and go” technology. Its compact size and cable-free design means it is ready for the field.

Robust Long-lasting battery (250 minutes) The long-lasting power source provides peace of mind as well as an accurate minute-by-minute onscreen battery indicator.

Drop and strength-tested to twice industry standards, the McGRATH® MAC EMS is designed to withstand tough clinical environments. Made from robust optical polymer supported by a reinforced CameraStick™, the blade delivers steellike rigidity.

Guaranteed sterility Infection control is achieved with sterile packaged blades and immersible handle for High Level Disinfection.

Direct or indirect use The McGRATH® MAC EMS can be used as a direct or indirect laryngoscope with or without the aid of a stylet to facilitate quicker adoption of technique and quicker tube placement.

McGRATH® MAC blade range The McGRATH® MAC 119 mm slimline single-use blade minimises obstruction of the tube path and is especially beneficial in cases of small pediatric patients. Blade sizes 2, 3, 4 are available, ensuring you have the range you need.

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McGRATH® MAC EMS

45˚

video laryngoscoope (the devide) Monitor Monitor hinge LCD screen

Handle

Clip Heel area Camera and light source CameraStick™

Handle overview • The CameraStick™ has a steel-reinforced chassis. It contains the CMOS camera and high-intensity LED. The blade covers and attaches to it during use. • The heel is where the curvature of the CameraStick™ begins • The screen connects to the handle by way of a hinge. The screen tilts by up to 45 degrees.

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Blade overview

Each disposable blade is for single patient use. They are made from a robust optical polymer and the lenses are coated with an anti-fog optical surface treatment. Sizes available are pediatric to large adult patients, with size 1 coming soon (neonate <8 weeks). Standard bades are packaged in cartons of 50, X blades are provided in packs of 10, all are packaged individually. Mac 2:

Pediatric Infant, for pediatric patients older than eight weeks or at least 4.5 kg

Mac 3:

Adult

Mac 4:

Large Adult

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Part II: Power

Power • The handle is supplied with one proprietary 3.6V Lithium Battery (nonrechargeable) in situ. It is embedded in the side of the handle • A new non-rechargeable battery provides up to 250 minutes of operating time under normal operating conditions • Battery minutes remaining are displayed on-screen. The battery icon begins flashing when reaches five minutes – change battery:

Flashing

• Remove the small plastic tab from a new battery before use:

McGRATH® 3.6V EMS Battery

Power button

Tab

• If the device won’t be used for more than one month, remove battery before storing

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Part III: How to Use

How to use 1

If possible, position the patient in the optimal position for direct laryngoscopy

2

Look into the mouth; insert the blade into the right side of the mouth

3

Move device to a central position while sweeping tongue to left

4

Advance the tip of the McGRATH® MAC blade into the vallecula

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5

Visualize the epiglottis on the screen. Lift the anatomy forward and upwards to expose a direct and indirect view of the glottis. When the device is in the optimal position the glottis should be viewed in the central upper section of the screen.

6

Advance the tube gently and atraumatically through the vocal cords. Tube placement can be performed either by looking directly in the mouth, indirectly on the screen or a combination of both.*

7

Indirectly visualize tube placement through the vocal cords. In optimal tube placement technique, E.T. tube will enter from right hand side of display.

8

Screen view can be used to confirm correct insertion depth of endotracheal tube

* If a direct pathway for the tube was not created by sweeping the tongue or aligning the airway axis a stylet or a bougie may need to be used. 12 | McGRATH® MAC EMS Video Laryngoscope

Improved view • Students should be made aware that typically, 1 to 2 grades of improvement in view are possible

In most cases expect a 1 grade of view improvement with McGRATH® MAC, although 2 grade and 3 grade conversions have been achieved.

Slim-line blade The 11.9 mm slim-line blade reduces blade width at the patient’s mouth, providing greater ability to maneuverer the device without pressing on teeth.

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Portrait view The portrait orientation of the screen ensures that the ET tube comes into view sooner. This reduces blind spots (time between tube disappearing in direct view and appearing on screen) and the risk of inadvertently inflicting soft palate injuries. Confirm students can successfully demonstrate.

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Part IV: Difficult Airways

Difficult airways Very few patients have anatomically extreme airways. However, they represent a difficult category of patient in whom airway management is particularly challenging. The MAC X blade™ has a more acute curvature that enables clinicians to see even further around corner. Students may struggle with the required modified technique. You should therefore pay particular attention to it in order to ensure that is successfully achieved.

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