1. McGrath MAC EMS Pilot Project
VIDEO LARYNGOSCOPE TRAINING
Welcome!
McGrath MAC EMS Pilot Project
6/7/2016

2. 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
Recognize indications of use per Maine EMS Protocol
Project QI
Examine the steps for device use
Understand how to change the battery
Comprehend device cleaning recommendations
Review answers to frequently asked questions
Project Pearls
This presentation is going to discuss the use of Intranasal naloxone by law enforcement and firefighters. Naloxone is the generic name while Narcan is the trade name. EMS providers must follow the Maine EMS protocols for their respective license level.
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3. Features Overview
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4. Benefits Provides both direct and indirect view
Use in routine intubation as well as difficult airways
Designed to reduce dental pressure
Increases working space
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5. Benefit: Improved Grade of View
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6. Device Overview
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7. Blades Overview MAC 2: Pediatrics, including infants MAC 3: Adults
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
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8. 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
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9. Equipment Check
VL Equipment Shall me inspected daily for functionality, number of correct available blades, video display and battery strength.
If missing equipment, notify your departments point of contact for the pilot project, who will notify Pete Landry from Physio Control to obtain replacement equipment.
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10. Indications for use per Maine EMS Protocol
Strict Adherence to Maine EMS Protocol in regards to Airway Management.
GCS of 3 and BLS airway has failed, secondary too
Difficult anatomy
Trauma
Vomit / Secretions
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11. (Project QI Box in the EMS Room)
VL Pilot Project QI
All Airway Patients Will Have a QI form filled and Submitted at Maine Medical Center
(Project QI Box in the EMS Room)
All forms will be reviewed my Doctor Martell “Project Medical Director”.
6/24/2014

12. How to use the McGRATH® MAC EMS Video Laryngoscope
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13. How to use: Step 1
If possible, place patient in optimal position for direct laryngoscopy (“sniffing” position).
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14. How to use: Step 2
Look into mouth; insert blade into right side of mouth.
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15. How to use: Step 3
Move device to a central position while sweeping tongue to left.
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16. How to use: Step 4
Advance tip of MAC blade into vallecula.
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17. How to use: Step 5 Directly visualize epiglottis.
Lift anatomy forwards and upwards to expose a direct and indirect view of glottis.
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18. How to use: Step 6
Advance tube gently through vocal cords.
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19. How to use: Step 7
With eyes directly visualize tube placement through vocal cords. The screen can assist with landmarks, but is NOT the primary view for intubation.
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20. How to use: Step 8
Screen view can be used to confirm correct insertion depth of endotracheal tube.
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21. Cleaning
Device should be decontaminated immediately after each patient use.
The following methods are approved by Aircraft Medical:
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22. Cleaning Device with Battery in Place
Prepare
Ensure cleaning containers, soft brushes and cloths have been decontaminated and are in good condition. Prepare container of detergent in accordance with detergent manufacturer’s instructions.
Clean
Hold device above container, and use soft cleaning brushes to remove soil from all exposed surfaces taking care not to scratch optical surfaces. Using a microfiber cloth, wipe all surfaces thoroughly ensuring that detergent solution comes into contact with all surfaces. Periodically rinse cloth and repeat. Scrub crevices and around hinged/mating surfaces with soft brush.
Rinse
Hold device over a large volume of rinse water and wipe down to remove all traces of detergent.
Repeat
Cleaning and rinsing steps should be repeated if device was heavily soiled or if soiling remains after cleaning.
Dry
Carefully hand-dry using clean, absorbent, non-shedding cloth.
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23. Cleaning Device with Battery Removed
Prepare
Ensure cleaning containers or sinks, soft brushes and cloths have been decontaminated and are in good condition. Prepare container of detergent in accordance with detergent manufacturer’s instructions.
Pre Clean
If visible soiling is present, immerse the device for a minimum of 5 minutes in enzymatic detergent solution prior to cleaning.
Clean
Immerse device for five minutes in fresh enzymatic detergent solution. Then, keeping the device immersed, use soft cleaning brushes to remove additional soil from challenging design features. Take care not to scratch optical surfaces. Scrub crevices and around hinged/mating surfaces with a soft brush.
Rinse
Remove device from solution and drain over detergent solution before transferring to a clean-rinse receptacle or sink. Rinse device thoroughly with clean water, ensuring that it is fully immersed. Remove device from rinse water.
Repeat
Cleaning and rinsing steps should be repeated if the device was heavily soiled or if visible soiling remains after cleaning.
Dry
Carefully hand-dry using clean, absorbent, non-shedding cloth.
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24. Rapid Disinfection
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:
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.
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25. Troubleshooting Behavior Action No image shown on screen
If when switched on, there is no display on the screen:
• Replace battery unit.
Poor picture quality
If 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.
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26. 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.
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27. 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.
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28. FAQs How long does the battery last? Is the battery rechargeable?
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.
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29. Project Pearls Adheres to Maine EMS Protocols
Airway Q/I form submitted for every airway call to be reviewed by Dr. Martell.
NO pediatrics in this study
Direct Visualization and EtCO2 are still required for intubations
Utilize a Boogie when Intubating
Always have a back up plan
Have traditional Laryngoscope prepared
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