Video Laryngoscopy in the Field
Objective: Use video laryngoscopy as Plan A when you are trained and authorized. Keep the bag, the bougie, and a spoken Plan B. A clear screen is not confirmation.
Why this matters
The screen can look clear while the sat falls, because nobody is bagging. Video laryngoscopy is a tool. You may still be on a bathroom floor. Limit the attempts. Give oxygen again. Do not repeat the same failed move.
- I give oxygen and I line the ear up with the sternal notch before I turn the screen on. The camera does not fix a flexed neck.
- Suction and a direct-laryngoscopy blade are out. Fog, blood, and sunlight wash out the screen.
- A still image is not confirmation. I want a continuous waveform. No sustained waveform means the tube is not in the trachea.
Clinical sequence
- Give oxygen and position the head first. Line the ear up with the sternal notch.
- Have suction and a direct-laryngoscopy blade ready. Do not leave the direct blade at the station because the service “only uses video now.”
- Use the stylet your training and the device require. A hyperangulated blade does not use the same stylet as a standard-geometry blade.
- Watch the tube pass the cords on the screen, or with your eye. Then look in the mouth as you withdraw the blade, so you did not leave the tube in the piriform sinus.
- Confirm with continuous waveform capnography. End-tidal carbon dioxide is that waveform. “I saw rings” with a flat trace is not a tracheal tube.
- If the sat is falling, or blood covers the lens, come out. Bag with two people. A two-handed jaw-thrust seal beats a one-handed E-C clamp. Change one thing: suction, position, a bougie, a different blade, or a supraglottic airway. A supraglottic airway is an acceptable advanced airway in adult cardiac arrest. A clear screen is not worth a hypoxic arrest.
Teaching points
- If the video laryngoscope will not turn on, go to the bag, the direct blade, the bougie, or a supraglottic airway. Say that Plan B before the first look.
- Blood on the lens with a falling sat means come out. Do not keep looking through a screen you cannot see.
Common errors
- Taking three video looks with no bag breaths between them.
- Calling the tube good because you saw rings while the waveform is flat.
- Carrying no direct-laryngoscopy blade because the service only uses video now.
Practice
One-minute check
Partner gives three cases. (1) The video view is clear, the tube is passed, and there is no waveform. What do you do first? (2) Blood is on the lens and the SpO₂ is 82%. Do you keep looking? (3) The patient is in arrest and the video laryngoscope will not turn on. What is the next tool? Answer each in one short sentence.
Related: Capnography, SGA.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; follow your protocol
- Difficult Airway Society guidelines hub — limit attempts, change something, oxygenate
- AHA 2025 Part 9: Adult ALS — SGA is an acceptable advanced airway during adult arrest
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.