1. ©2013 Physio-Control, Inc. VIDEO LARYNGOSCOPE TRAINING

2. ©2015 Physio-Control, Inc. Introduction Refer to the McGRATH ® MAC EMS Operator's Manual for complete directions for use, warnings and precautions. Refer to your organization’s protocols or policies regarding the use of the video laryngoscope.

3. ©2015 Physio-Control, Inc. Introduction The McGRATH ® MAC EMS Video Laryngoscope is a tool used to aid the intubation of the trachea. As a rigid laryngoscope, it holds and shapes the anatomy allowing a clear view of the larynx and entrance to the trachea.

4. ©2015 Physio-Control, Inc. Objectives Upon completion of this presentation, participants will be able to:  Discuss the features and benefits of the McGRATH ® MAC EMS Video Laryngoscope  Understand the basic components of the device  Examine the steps for device use  Understand how to change the battery  Comprehend device cleaning recommendations  Review answers to frequently asked questions

5. ©2015 Physio-Control, Inc. Features Overview

6. ©2015 Physio-Control, Inc. Benefits Provides both direct and indirect view Use in routine intubation as well as difficult airways Designed to reduce dental pressure Increases working space

7. ©2015 Physio-Control, Inc. Benefit: Improved Grade of View

8. ©2015 Physio-Control, Inc. Device Overview

9. ©2015 Physio-Control, Inc. Blades Overview  Disposable, single use  Blade lenses are coated with anti-fog optical surface treatment  Slide the blade over the CameraStick ™ until the blade clip is firmly latched  Remove the blade, lift the clip and pull the blade off  Sizes:  MAC 2: Pediatrics, including infants  MAC 3: Adults  MAC 4: Large adults

10. ©2015 Physio-Control, Inc. Battery 3.6V Lithium non-rechargeable battery Embedded in side of handle Up to 250 minutes operating time Battery minutes remaining displayed on screen Battery icon flashes when five minutes of operating time remaining Change battery by pulling the tab on handle Insert new battery

11. ©2015 Physio-Control, Inc. How to use the McGRATH ® MAC EMS Video Laryngoscope

12. ©2015 Physio-Control, Inc. How to use: Step 1  If possible, place patient in optimal position for direct laryngoscopy (“sniffing” position).

13. ©2015 Physio-Control, Inc. How to use: Step 2  Look into mouth; insert blade into right side of mouth.

14. ©2015 Physio-Control, Inc. How to use: Step 3  Move device to a central position while sweeping tongue to left.

15. ©2015 Physio-Control, Inc. How to use: Step 4  Advance tip of MAC blade into vallecula.

16. ©2015 Physio-Control, Inc. How to use: Step 5  Visualize epiglottis on screen.  Lift anatomy forwards and upwards to expose a direct and indirect view of glottis.

17. ©2015 Physio-Control, Inc. How to use: Step 6  Advance tube gently through vocal cords.

18. ©2015 Physio-Control, Inc. How to use: Step 7  Indirectly visualize tube placement through vocal cords.

19. ©2015 Physio-Control, Inc. How to use: Step 8  Screen view can be used to confirm correct insertion depth of endotracheal tube.

20. ©2015 Physio-Control, Inc. Cleaning Device should be decontaminated immediately after each patient use. The following methods are approved by Aircraft Medical:

21. ©2015 Physio-Control, Inc. Cleaning Device with Battery in Place

22. ©2015 Physio-Control, Inc. Cleaning Device with Battery Removed

23. ©2015 Physio-Control, Inc. Rapid Disinfection 1. Monitor: Ensure the wipe gets into the various grooves around screen. 2. Monitor Hinge: Rotate monitor to upright position. Feed wipe into space between monitor and handle to ensure effective penetration. Rotate monitor to its opposite position and repeat. 3. Battery Cover: Ensure joint between battery module and handle are thoroughly treated with wipe. 4. Heel Area: Take particular care in ensuring the small metal clip feature is clean, in particular, internal corner between the clip and surrounding plastic body. 5. Camera: Locally scrub around camera lens to ensure that interface between metal CameraStick™ and camera lens is clean. A low level disinfection process should only be considered where High Level Disinfection and Sterilization processes are not practical. Ensure that all surfaces of device are covered, even if no visible soiling is present. Systematically work from top to bottom:

24. ©2015 Physio-Control, Inc. Troubleshooting BehaviorAction No image shown on screenIf when switched on, there is no display on the screen: Replace battery unit. Poor picture qualityIf the image displayed on the screen is blurred or fuzzy: Replace the blade Remove the blade and check that the image is clear. If necessary, wipe the camera at the end of the CameraStick™ with a clean, soft wipe.

25. ©2015 Physio-Control, Inc. FAQs Can the disposable blade be re-used? Each blade is single use and is supplied sterile. The blades have been designed to be used once and meet all regulatory and practical strength requirements required for safe intubation. What blade sizes are available? Three lengths, equivalent to Macintosh sizes 2, 3 and 4. Does the blade bend? The blade is designed to be as strong as steel. It is made from a robust optical polymer and slides over a reinforced metal alloy CameraStick™ for extra support. Do the blades fog? No. They are coated with anti-fog treatment which means no need to treat or heat the blade–optical surfaces help eliminate moisture droplets forming.

26. ©2015 Physio-Control, Inc. FAQs What do you mean by a direct and indirect view? Direct view is the ability to view the anatomy using the naked eye (as with typical intubation). Indirect view is to view the anatomy using a camera and monitor. Can I use the McGRATH ® MAC EMS for difficult airways? Yes, the device has a number of difficult airway features including a video supported anterior visualization which is designed to improve grade of view and requires less force, addressing tube trauma and complications. The ultra slim-line blade also increases agility and manipulation supporting cases involving small mouth openings and nasal intubations. Is the McGRATH ® MAC EMS for non-difficult airways only? Combining video and direct visualization the McGRATH ® MAC EMS supports routine to more difficult intubations and reduces the use of multiple devices. The device invests in existing skills, improves grade of view and avoids complicating more simple intubations.

27. ©2015 Physio-Control, Inc. FAQs How long does the battery last? The battery lasts up to 250 minutes so the device is always ready to use. The accurate minute-by-minute on screen battery charge indicator also provides useful information. Is the battery rechargeable? The battery is single use and should be responsibly disposed of when it becomes depleted. How can I clean the device? Infection control is achieved with sterile packaged blades and fully immersible handle for High Level Disinfection.

28. ©2015 Physio-Control, Inc. Redmond, WA. GDR 3324404_A. All names herein are trademarks or registered trademarks of their respective owners.

29. ©2015 Physio-Control, Inc. Optional Slides

30. ©2015 Physio-Control, Inc. McGRATH ® X blade ™ A key distinguishing feature of the X blade is its extreme curvature which is considerably more acute than the existing range of Macintosh-like McGRATH ® MAC blades.

31. ©2015 Physio-Control, Inc. Features A sweeping acute curvature for extreme anterior airways and for patients where minimal manipulation is a requirement Reduced bulk for extremely narrow mouth openings (and optimal tube space) Portrait optics to help reduce ‘blind spot’ soft palate injury risks Anti-fog to help reduce fogging in the majority of cases DepthGuide™ for enhanced training and communication

32. ©2015 Physio-Control, Inc. Indications for Use A larynx that is positioned extremely anteriorly A mouth opening that is extremely narrow or restricted Where the opportunity to manipulate or reposition the patient is extremely limited Abnormal or restricted oropharyngeal views Traumatized airways where blood and secretions are present

33. ©2015 Physio-Control, Inc. How To Use: Step 1 Load ET tube onto a stylet and form to curvature of X blade

34. ©2015 Physio-Control, Inc. How To Use: Step 2 Elevate patient’s head into “sniffing” position for optimal access.

35. ©2015 Physio-Control, Inc. How To Use: Step 3 Using a mid-line approach, roll blade into mouth, ensuring anterior side of blade maintains contact with tongue. Advance blade until epiglottis is seen on top of screen.

36. ©2015 Physio-Control, Inc. How To Use: Step 4 Place tip of X blade into vallecula.

37. ©2015 Physio-Control, Inc. How To Use: Step 5 Using minimal force, rock device back towards user to lift epiglottis and obtain an indirect view of glottis.

38. ©2015 Physio-Control, Inc. How To Use: Step 6 When device is in optimal position, glottis will be viewed in central upper section of screen.

39. ©2015 Physio-Control, Inc. How To Use: Step 7 DepthGuide TM numeric markings on the posterior side of blade may be used as indication of depth of blade insertion.

40. ©2015 Physio-Control, Inc. How To Use: Step 8 Insert ET tube at right side corner of mouth. Advance in a rolling movement following the curvature of blade, ensuring it maintains contact with section of blade labelled E.T. CONTACT ZONE.

41. ©2015 Physio-Control, Inc. How To Use: Step 9 When using optimal technique, ET tube should enter screen on right hand side. Advance tube until tip is in front of vocal cords.

42. ©2015 Physio-Control, Inc. How To Use: Step 10 Holding stylet secure, slide tube off stylet and through cords, ensuring stylet does not pass through cords Once tube has passed through cords remove stylet completely

43. ©2015 Physio-Control, Inc. How To Use: Step 11 Screen view can be used to confirm correct insertion depth of endotracheal tube.

44. ©2015 Physio-Control, Inc. Redmond, WA. GDR 3324404_A. All names herein are trademarks or registered trademarks of their respective owners.