enhanced approach An additional advantage of VL is the ability for multiple practitioners to view the procedure simultaneously This allows for real-time guidance and supervision during TI Oftentimes in emergency medicine, patients require rapid airway management without the benefit of prescreening or comprehensive airway assessments, and by providers who have less frequent occasions to perform invasive airway procedures Therefore, the recognized advantages of VL may be underestimated in research studies A number of VL devices are available for use in pediatrics, varying in their cost, design, reusability, and technique for use ( e-Table 8.1 ) Currently, only a limited number offer sizing that allows for use across the entire spectrum of ages, from neonates through to adolescents The GlideScope and the Storz C-MAC are currently the two most popular products in use in pediatric emergency medicine The GlideScope utilizes a J-shaped baton in conjunction with a hyperangulated blade and a styletted ETT Alternative GlideScope blades that enable DI are currently available in adult but not pediatric sizes The Storz C-MAC utilizes more conventional blade geometry which closely mimics DI Nonetheless, the vantage point from the camera at the distal tip of the blade offers improved views over those available directly In addition, the C-MAC now has a pediatric and adult hyperangulaged “D” blade that may be advantageous for patients in whom a direct line of sight is likely to be challenging, as described above King Vision devices are newer videolaryngoscopes that also utilize a baton with disposable single-use blades The size blade is unchanneled and requires concurrent use of a styletted ETT The pediatric and adult blades (sizes and 3) come with either channeled or unchanneled blades The cost is significantly lower than the C-MAC and GlideScope systems There are other subtle differences that are beyond the scope of this chapter and products in this market are constantly evolving to improve PREOXYGENATION Given the risk of rapid desaturation in children, efforts should be made to maximize preoxygenation Preoxygenation in children in the ED is traditionally performed using a nonrebreather mask, which can be supplemented with a nasal cannula Flush rate oxygen delivery through a nonrebreather can limit entrainment of room air during preoxygenation in adults, although it is not clear if increasing flow beyond 15 liters per minute (L/min) is beneficial in younger pediatric patients with smaller minute ventilation Bag mask ventilation can be used to increase the delivered FiO2 with positive pressure breaths Spontaneously breathing infants and young children may not have the inspiratory force to open