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Blade sizes for intubation

Discussion in 'Firefighter/EMS Talk' started by Chicks&Ammo, Apr 29, 2007.

  1. Chicks&Ammo


    Mar 25, 2006
    Any general rules for picking out a blade style and size when intubating? We carry curve blades #3 and 4 and straight blades #2,3 and 4, which gives me a lot of options. I haven't found a favorite between using a straight blade or curved blade, if one doesn't work I try the other. Any thoughts or suggestions?
  2. Glkster19


    May 12, 2001
    Lansing, MI
    Service I work for has a View Max, it is available only in 1 adult size and I believe it is in the middle of a 3 and 4 curved blade. Before that I always grabbed a Mac 4 for all avg size adults. Better to have too much blade than not enough. A longer blade can be pulled back where a shorter blade is only going to get you so far down.

  3. psaK9


    Apr 1, 2007
    I have found that a Mac 3 works best for most adults. While the Miller works much better for Infants and Children. Just my personal findings... its like anything else, use what works for you, as long as you get the tube w/o damage to pt, no one will ever question you... another thought on kids is to use the broslow tape (can be found in AHA ACLS book) it will tell you what size equipment to use depending on the size of the patient... Justin
  4. Chicks&Ammo


    Mar 25, 2006
    Thanks for the tip. We do keep a braslow tape in the pedi airway kit which makes it easier (besides the usual pucker factor of having to tube a kid). I have typically been grabing the largest blade size on an average size adult, but I was just trying to hone my skills and consider the use of the other sizes.
  5. gruntmedik

    gruntmedik Honk Honk CLM

    Jan 2, 2005
    Taylorsville, KY
    How do you like the View Max? We had one on loan a couple years ago, but decided against it. I was knda indifferent about it. We also had some Grandview blades for adult and peds, and I liked those pretty well.

    I also reach for the 4 Miller most of the time, but have found that for pt's with a C-collar on, I use the 4 Mac, and use it like the Miller. Very little, if any, unnecessary manipulation.
  6. MD2010


    Feb 17, 2007
    Norfolk, VA
    The blade style is really a matter of preference I think. I have always had successful intubations with the curved blades so that's what I always go for first. I think it's just a matter of what you like, what you're comfortable with, and what works for you. I would say just keep dummy practicing, get your first few real ones (i'm assuming by your question you're still in class), and you'll eventually find one that you're comfortable with and will be like second nature to use. As far as the size goes, Mac 3 works best for most adults. A good rule of thumb for sizing them is to hold the top next to the mouth and see how far down the blade goes and how big it looks next to the person. You'll be able to quickly notice if it looks like it will probably be too big for their airway.
  7. Glkster19


    May 12, 2001
    Lansing, MI

    Took some getting used to, but after a while they are great to use. They are even better if the person is wearing a collar, the 20* forward view is great when trying to keep c-spine in line. We've had it for a few years now and after using it for a while I wouldn't give it up. Thinking about it, I think I'm the only 1 that uses it, the other medics are old farts and still use a Miller :supergrin:
  8. Dean


    Nov 4, 2006
    "Any general rules for picking out a blade style and size when intubating? Any thoughts or suggestions?"

    Here's the deal:

    Mac #3 for most regular sized adults and #4 for tall adults. Of course if you have choked up on the handle so that the rear of the blade is in your palm, you can intubate almost anyone just by adroitly controlling blade depth while sweeping the tongue from right to left. With the blade in the valleculae lift and sweep, using your forearm on the forehead for stability and your left palm as a fulcrum.
    Try it on the mannequin. :drillsgt:
  9. RyanNREMTP

    RyanNREMTP Inactive/Banned

    Jun 16, 2007
    Waco, Texas
    I prefer the Grandview blade on adults, but it all comes down to preference. Practice, practice and practice with all blades before trying to decide while working on a real patient.
  10. Hunca Munca

    Hunca Munca nonplussed

    Dec 20, 2006
    allegheny county
    The Macintosh or curved blade is designed to fit in the vallecula. (the pocket above the epiglottis)You then lift the epiglottis out of the way.

    The Miller or straight blade is designed to fit under the tip of the epiglottis and lift it.

    The numbers relate to size. #4 is bigger than #3 etc.

    I find that with the miller the tongue tends to flop over and limit your view so I prefer the Mac.

    However, you should be familiar with both as you may need to change blades at some point to intubate.
  11. Joey

    Joey Millennium Member

    Sep 14, 1999
  12. Hunca Munca

    Hunca Munca nonplussed

    Dec 20, 2006
    allegheny county

    King Lt-D :tongueout: :tongueout: :tongueout: :tongueout:
  13. DaleGribble

    DaleGribble Sandwich!

    Mar 20, 2003
    Land of the toothless!
    I've always used a #3 mac.

    Anybody ever done digital? I learned the technique in paramedic class about a month ago and I'm itching to try it but my last two intubations were on live pt's, both with an intact gag reflex, so I wasn't sticking my fingers in there. On the mannequin it's way easier.
  14. IMO, if you get where you can nail intubations with a miller, you're golden. Now consider that comment is coming from a trauma provider in a hospital setting, not as a first responder.
  15. tacticaljoey


    Dec 27, 2006
    Mac #3 or #4 for adults. Miller for Peds, their epiglotis is just too floppy for a Mac in my opinion.
  16. 4095fanatic


    Oct 12, 2006
    For adults, usually a Miller 3. I know a lot of ppl aren't miller fans, but you can gain a little better angle with your wrist IMO because the blades isn't as thick. If it's a real big boy, though, Mac 4 all the way.