# Curved vs. Straight blades



## Carlos Danger (Oct 3, 2016)

What are paramedics being taught about the differences between the two basic laryngoscope blade designs?


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## VentMonkey (Oct 3, 2016)

Remi said:


> What are paramedics being taught about the differences between the two basic laryngoscope blade designs?


Provider preference, not much more that I am aware of, though I'd love a CRNA's insight.

Now, where can I find one?...


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## TransportJockey (Oct 3, 2016)

Provider preference with Millers being easier for neos and pedis due to how they pin the epiglottis. And that Grandviews are so easy its like cheating

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## NomadicMedic (Oct 3, 2016)

I love the grandview. It's like intubating with a snow shovel. 

I also learned it was provider preference. 

However, in clinicals, a rather salty CRNA was telling me that he intubated almost everyone with a miller 2. He said, "the blade doesn't really matter after you've done 500 or so." He told me it was all about knowing the anatomy and your limitations. He also showed me a few different techniques that I thought were pretty neat.


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## VentMonkey (Oct 3, 2016)

I feel like a Miller just doesn't give me the control I want for the majority of the adult population, particularly with large tongues.

I'm a Mac #4 guy myself. I feel it gives me the best shot at shoving everything off to the left allowing for a cleaner view, and it also provides the most maneuverability with most adults. 

If it doesn't work the first time, I always keep a Mac #3 handy for my second attempt.


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## TransportJockey (Oct 3, 2016)

VentMonkey said:


> I feel like a Miller just doesn't give me the control I want for the majority of the adult population, particularly with large tongues.
> 
> I'm a Mac #4 guy myself. I feel it gives me the best shot at shoving everything off to the left allowing for a cleaner view, and it also provides the most maneuverability with most adults.
> 
> If it doesn't work the first time, I always keep a Mac #3 handy for my second attempt.


My go-to is a King Vision w/ adults, with a Mac 4 as backup (the KV is roughly a 3.5 Mac-ish blade)


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## VentMonkey (Oct 3, 2016)

TransportJockey said:


> My go-to is a King Vision w/ adults, with a Mac 4 as backup (the KV is roughly a 3.5 Mac-ish blade)


Our protocols dictate that we are to utilize DL first before moving to our King Vision.

Essentially, my approach would me DL/ Mac #4 and "Kiwi Grip" Bougie--->DL/ Mac #3 and "Kiwi Grip" Bougie---> King Vision.


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## Nova1300 (Oct 3, 2016)

This is a bit embarrassing to admit, but when I was slick at intubating I liked straight blades.  However, now that I spent most of my time on the sidelines watching trainees intubate, I almost always reach for a Mac 3 when I have to step in.  The few days per year I spend in the OR, I almost always ask the CRNA to let me intubate while they push drugs.  And I go Mac 3.  And I know they judge me for it


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## VentMonkey (Oct 3, 2016)

Nova1300 said:


> This is a bit embarrassing to admit, but when I was slick at intubating I liked straight blades./QUOTE]
> Nothing to be embarrassed of, IMO. It's been always taught as personal preference as long as I have known.
> 
> Out of curiosity, what was it that drew you to the Miller, and how did it help you in particular?
> ...


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## Carlos Danger (Oct 3, 2016)

I saw something somewhere on the interwebz recently where a paramedic said something about how certain blades are better for certain anatomy. I've heard similar things many times in the past, but I've never heard it explained. So I always wondered what the person saying it was talking about. Just wondered what you guys had learned about it.

In my CRNA training I don't remember ever even discussing it really. "You'll figure out what you like to use" was pretty much all we were taught about the blades. I do think it primarily comes down to personal preference.

When I was in the field I mostly used straight blades, because I was taught that most difficult airways are more amenable to straight blades. I continued using straight blades during CRNA school. One day a CRNA that I was working with said "Dude, curved blades are just easier to use. Why wouldn't you want to use what is easier?" Later in my training, an anesthesiologist who I liked a lot told me that "a miller 2 is the only blade worth knowing", his rationale being that while in most patients it doesnt matter at all which you use, there are some that a straight blade works better in, so it makes sense to use that blade type routinely so you are really comfortable with it in the case that you need it.

Since I finished my training about 1.5 years ago, I've been using curved blades pretty much exclusively. I'll reach for a straight blade now and then just because. I really think curved blades are easier to use in general - they just take a little less work to get a good view with. I like a mac 3.5 if I can get one (we don't have them where I work now, unfortunately), or a mac 4. The only time I think straight blades are really better (as in easier to use) are in patients with a really small mouth opening - there's just less metal to try to fit between the teeth.


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## VentMonkey (Oct 3, 2016)

Ya know? It's threads like this that really make me glad I joined this forum.


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## Nova1300 (Oct 3, 2016)

It's funny, I never really sat down to contemplate why I grew to like the straight blade in my early years.  I liken it to smoking, everyone was doing it and it looked cool.  

I was taught a peritonsillar placement for straight blades and a hefty sweep up and left.  And with a good deal of practice, I eventually was able to get better views on most patients with this technique than I could obtain with a Mac.  But like many things in life, if you don't use it, you lose it.  


I wouldn't touch an edematous, gastric tube-filled, slimy ICU patient larynx with a straight blade now.  The art of intubation is lost on me in this population. It's more of a "shove as much as you can out of the way with the blade and suck out the remaining crust with the rigid suction catheter until you see something that resembles a vocal cord" approach.  

I probably look like an orthopod trying to intubate in these situations.  Shame.


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## Handsome Robb (Oct 3, 2016)

I was taught that straight blades you place the tip on the epiglottis and pin it out of the way whereas a curve you place the tip into the vallecula and lift which pulls the epiglottis out of the way. 

I used to cheat and use a grandview as my first choice but once we went to disposable blades I'd use a Miller 2-3 depending on how I was feeling. 

Now I'm required to use the King Vision on all intubations so it's a moot point. 


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## DesertMedic66 (Oct 3, 2016)

Handsome Robb said:


> I was taught that straight blades you place the tip on the epiglottis and pin it out of the way whereas a curve you place the tip into the vallecula and lift which pulls the epiglottis out of the way.


I was taught that also. For us during medic school we were forced to use both straight and curved to find out what we preferred. 

We were also taught that usually straight is easier for infants however sometimes curved will work better.


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## Handsome Robb (Oct 3, 2016)

DesertMedic66 said:


> We were also taught that usually straight is easier for infants however sometimes curved will work better.



I was taught the same thing. I've actually intubated more kids than adults. Ok it's probably about even now actually and I never had an issue using Miller blades for them. Never tried a mac blade though.


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## NomadicMedic (Oct 3, 2016)

There's no VL at my current service, so I'm a kiwi grip bougie and mac 4 guy usually. (Every tube is on a dead person during CPR, so I make it easy on myself)


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## akflightmedic (Oct 3, 2016)

I prefer my digits...ain't nothing like hooking in their mouth the way you noodle for a catfish. Hit the sweet spot and drop the tube...why mess with any blade when you can noodle?


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## VentMonkey (Oct 3, 2016)

akflightmedic said:


> I prefer my digits...ain't nothing like hooking in their mouth the way you noodle for a catfish. Hit the sweet spot and drop the tube...why mess with any blade when you can noodle?


Our medical director is huge on bimanual ELM (detests cric pressure; another "hot button" airway topic), and had emphasized how it frees your hands to do such things as manipulate the airway to your liking. 

I have also seen/ heard of utilizing a second provider to "fish hook" the cheek for even further maneuverability/ wiggle room.


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## NomadicMedic (Oct 3, 2016)

In a difficult airway class I medic school I learned the tomahawk method, where a second provider stands over the patient and pulls straight up on the handle. Shortly afterward, I used it on a 500 pound Samoan guy and it worked like a champ. My preceptor about **** himself.

They were busting my balls, "hey medic student, can you get this tube?" Damn right I'll get that tube.

Now, of course, I'd be all like, "just put a king in..."


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## VentMonkey (Oct 3, 2016)

DEmedic said:


> In a difficult airway class I medic school I learned the tomahawk method, where a second provider stands over the patient and pulls straight up on the handle. Shortly afterward, I used it on a 500 pound Samoan guy and it worked like a champ. My preceptor about **** himself.
> 
> They were busting my balls, "hey medic student, can you get this tube?" Damn right I'll get that tube.
> 
> Now, of course, I'd be all like, "just put a king in..."


When you say difficult airway class, are you referring to thee "Difficult Airway Course" designed to coincide with the Ron Walls book?

I was thinking about taking the one in LV later this year, but scheduling changes prevented me from following through. I'm wondering if anyone has taken it, and if so what they thought.


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## NomadicMedic (Oct 3, 2016)

This was a *******ized version, fully unauthorized I'm sure, that did use stuff from Wall's book (and his algorithms) and was taught by a couple of medics and a CRNA, who used to be a medic. I had the opportunity to take the real class a few years again and missed it due to scheduling. Everyone said it was very good. 

I took SLAM, street level airway management, and that was pretty good. Lots of little tips and tricks to stack the deck in your favor. The guy that taught it was all about war stories, which was a little offputting.


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## TXpeds16 (Oct 3, 2016)

Like others have said, it is completely provider preference.  While working pre-hospital I preferred a mac 3.  Nowadays I work for a pediatric transport team and in most cases a miller 2 does the trick; however, with larger pediatrics and adults I still use a mac 3.


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## SeeNoMore (Oct 4, 2016)

Most providers I know rarely use a straight blade on an adult. I generally use a Mac 4 w/ a bougie on every intubation that I don't choose to use VL (other than peds of course.)


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## StCEMT (Oct 4, 2016)

We were told general rule of thumb was Mac for adults and Miller for peds and then to experiment and see what we like. I haven't intubated any crappy airways yet, but I have so far personally preferred the 3 Miller. Always felt like it took less effort to get the epiglottis out of the way.


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## VentMonkey (Oct 4, 2016)

My most recent RSI actually had surprisingly large teeth, and a large tongue for what looked to be an otherwise normal airway; slightly anterior also.

I stuck it out with my Mac 4, though in retrospect I suppose I could have downgraded to the Mac 3 for easier manipulation.

Either way it turned out fine, and I am happy to report all teeth were in tact, and remained un-chipped and accounted for in the end.

The kiwi grip bougie trick was my takeaway here, as I found once I ever so gently swept the tongue out of the way,and pulled up and towards the feet, I was able to get a good grade 3 view allowing for a fairly easy pass.

My takeaway here is that even though the airway had the potential for difficulty, proper set up (suction ready, Mac 3 set up, tube tamer ready, ETCO2 ready, etc.), and preparation seems much more pertinent than the blade type itself, aside from peds that is; certainly "da bey-bez" get the Miller blade.


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## SeeNoMore (Oct 5, 2016)

If you are competent, educated and prepared you should be able to calmly transition to a new blade or approach if there is a need for it. I think the problems arise when providers start missing , panicking and just grabbing devices or new blades without a plan. I think the best example of this is when medics can't get a view with DL and then reach for a VL device they never practice with and don't understand. Bad news.


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## VentMonkey (Oct 5, 2016)

SeeNoMore said:


> If you are competent, educated and prepared you should be able to calmly transition to a new blade or approach if there is a need for it. I think the problems arise when providers start missing , panicking and just grabbing devices or new blades without a plan. I think the best example of this is when medics can't get a view with DL and then reach for a VL device they never practice with and don't understand. Bad news.


Agreed. Even though "Fred the Head" is straightforward practice, I'll still give him a whirl with our VL when downtime permits at our base.

Simply being familiar with how to use whatever  VL or back up device (let's not exclude proper SGA placement) it is you use is the key to a calm, cool, and collected approach.

I always find it ironic how the lazier providers typically bark the loudest, but are easily rattled. To me, preparation begins with something as simple as checking out your equipment at the beginning of _EVERY SHIFT_ (ugh, how dare your employer expect you to do your job?!), and setting it up exactly how YOU want it does wonders for a calmed providers approach.

No real secret really, just don't be a lazy jackass.

Side note: any non-Wilco EMS paramedic using the KV as a VL, I highly recommend giving Dr. Jarvis' tutorial(s) a gander...


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## Tigger (Oct 5, 2016)

In class we were taught to directly manipulate the epiglottis with a Miller and to place Macs in the vallecula, though you also have the option of pinning the epiglottis with it if you wanted to. I think it is easier to move the tongue out of the way with a Mac, so that is what I reach for. But really, it comes down to your preference. All the ED docs used Macs and all the anesthesiologists I did rotations with used curved blades if they weren't using VL for every tube. There was one who liked to switch off, but he seemed to like challenging himself and I found him slacklining in the park one day. 

My regular partner and mentor is a mac person. But my captain, who I run a lot of calls with, will immediately question my use of a curved blade. "That blade is for [insert choice term for female anatomy]. It sucks. If they are anterior, you can't get the tube. Grandviews are also for [same term]. You will use a Miller, because that's what will bail you out." I think that is crap and try very hard to not let it effect me, but it is hard. The guy is a rather abrasive but exceptional paramedic. If I needed to be intubated, I want him to do it. But for me, I think the Mac 4 is easier. Which is the goal, make it as easy as possible. We do not have enough grandviews for our all our kits and they won't order more. I wrote a grant for McGraths, there is a huge amount of pushback to even carry them in the bags. 

I do not care how I get the tube so long as I don't do damage and I get it done efficiently yet I get pressure to do things a certain way, which is absurd to me. I want to use a bougie on every tube as well, you can imagine how that is going...


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## StCEMT (Oct 5, 2016)

Tigger said:


> I wrote a grant for McGraths, there is a huge amount of pushback to even carry them in the bags.
> 
> I do not care how I get the tube so long as I don't do damage and I get it done efficiently yet I get pressure to do things a certain way, which is absurd to me. I want to use a bougie on every tube as well, you can imagine how that is going...


Why is there pushback on the McGrath? My local medics have had them for a while and a few have said that they have had intubations (bloody airways etc) that it was really helpful with. Seems nice also if you are in a less than ideal position/environment...

Have you gotten the "it is a crutch" line about using a bougie? I didn't argue it in the OR, but in the field people can piss off. Makes no sense to argue against being proficient with a tool to help complete the task.


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## VentMonkey (Oct 5, 2016)

Tigger said:


> In class we were taught to directly manipulate the epiglottis with a Miller and to place Macs in the vallecula, though you also have the option of pinning the epiglottis with it if you wanted to. I think it is easier to move the tongue out of the way with a Mac, so that is what I reach for. But really, it comes down to your preference. All the ED docs used Macs and all the anesthesiologists I did rotations with used curved blades if they weren't using VL for every tube. There was one who liked to switch off, but he seemed to like challenging himself and I found him slacklining in the park one day.
> 
> My regular partner and mentor is a mac person. But my captain, who I run a lot of calls with, will immediately question my use of a curved blade. "That blade is for [insert choice term for female anatomy]. It sucks. If they are anterior, you can't get the tube. Grandviews are also for [same term]. You will use a Miller, because that's what will bail you out." I think that is crap and try very hard to not let it effect me, but it is hard. The guy is a rather abrasive but exceptional paramedic. If I needed to be intubated, I want him to do it. But for me, I think the Mac 4 is easier. Which is the goal, make it as easy as possible. We do not have enough grandviews for our all our kits and they won't order more. I wrote a grant for McGraths, there is a huge amount of pushback to even carry them in the bags.
> 
> I do not care how I get the tube so long as I don't do damage and I get it done efficiently yet I get pressure to do things a certain way, which is absurd to me. I want to use a bougie on every tube as well, you can imagine how that is going...


Brother, fret not. As I would tell all my interns..."you will find YOUR groove." And when you do, you stick with what works for YOU.

I find it all ego, and hoopla when people argue over one vs. the other. It truly is what YOU are most comfortable with. Although I will say I find Bougies have worked wonders for first pass success rate for me.

Good luck, and once you find your groove, the skill itself is like any other "monkey skill", it's pieceing everything else around it that makes for a prudent clinician.


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## jwk (Oct 5, 2016)

My tongue in cheek answer is that anyone can muscle a tube in with a straight blade, but it takes far more skill and finesse to use a curved blade.

I think straight blades are generally more traumatic, and most airway/dental injuries I see caused by others happens with straight blades.

The best blade to use is the one you have the most success with.  I use a Mac 3 for 99% of by DL's.

Most people I see using a Miller 2 are using it like a curved blade anyway - it's frequently not long enough to lift the epiglottis
.

Curved blades work fine with infants if you practice with them - the idea that a straight blade is the only one to use for pedi cases is crap.


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## Tigger (Oct 5, 2016)

StCEMT said:


> Why is there pushback on the McGrath? My local medics have had them for a while and a few have said that they have had intubations (bloody airways etc) that it was really helpful with. Seems nice also if you are in a less than ideal position/environment...
> 
> Have you gotten the "it is a crutch" line about using a bougie? I didn't argue it in the OR, but in the field people can piss off. Makes no sense to argue against being proficient with a tool to help complete the task.


Oh yea. "So why did you think it was a difficult airway that needed a bougie?"

I didn't think it was a difficult airway. But I don't find out the hard way. Also, I can't see how the bougie is going to help in a disaster airway if I am not already comfortable using it. Therefore I want to use it all the time.


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## SeeNoMore (Oct 5, 2016)

I just use the bougie 100 percent of the time. I figure if I treat every airway like its going to be difficult I'll be ahead of the game when it really is.


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## Tigger (Oct 5, 2016)

SeeNoMore said:


> I just use the bougie 100 percent of the time. I figure if I treat every airway like its going to be difficult I'll be ahead of the game when it really is.


That is my logic, I get a lot of weird looks.


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## TransportJockey (Oct 5, 2016)

SeeNoMore said:


> I just use the bougie 100 percent of the time. I figure if I treat every airway like its going to be difficult I'll be ahead of the game when it really is.


Thats my thought too. I get weird looks and annoy people for it

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## Handsome Robb (Oct 5, 2016)

VentMonkey said:


> Side note: any non-Wilco EMS paramedic using the KV as a VL, I highly recommend giving Dr. Jarvis' tutorial(s) a gander...



"Howdy y'all!"

I personally. Like the KV we've got a first pass success rate in the 90s. It would be even higher if having to back out to clean the camera because it got gunked didn't count as a miss. 


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## NomadicMedic (Oct 5, 2016)

Funny, I use a bougie on 100% of my tubes and get the funny looks too. I was asked, "did you think that was going to be a tough tube?" Nope. But I use a bougie every time, because I'd rather stack the deck in my favor.


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## akflightmedic (Oct 5, 2016)

Agreed. You have a tool which has proven it's usefulness time and again and is darn near or should be the standard, yet people who prefer to keep it as a "back up assist device" or let their pride/ego get in the way. Ummm, we have a human in front of us who needs an airway...if you provide one you are still a "hero". 

The human condition confounds me repeatedly. Just like lift assists...yeh I could do 90% or more of the lifts on my own, but why should I when I have other tools/people there to lessen the risk? Ugh...


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## EpiEMS (Oct 5, 2016)

Seems like the problem is as much cultural as it is anything else.
Love this convo, guys!


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## Handsome Robb (Oct 5, 2016)

We use a bougie on every attempt, we'll sort of. We preload the ETT into the king vision then preload the bougie into the ETT however don't extend it past the tip of the ETT. If you can pass the tube without it great, if you need it it's right there and ready to go. 


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## Carlos Danger (Oct 5, 2016)

Several have mentioned the Grandview blade. I used one once a long time ago and thought it was pretty awesome. But last I knew they weren't making them for use with fiberoptic handles. Is that still the case?


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## VentMonkey (Oct 5, 2016)

DEmedic said:


> View attachment 3042
> 
> 
> 
> ...


I think a great follow up t-shirt to this would say something along the lines of "the kiwi grip saved my ***". I really do enjoy that nifty little trick for DL.


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## Handsome Robb (Oct 5, 2016)

VentMonkey said:


> I think a great follow up t-shirt to this would say something along the lines of "the kiwi grip saved my ***". I really do enjoy that nifty little trick for DL.



I've never heard of this kiwi grip. Going to have to look it up. I'm sad we don't use DL anymore but with that said I do really like the KV. 


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## NomadicMedic (Oct 5, 2016)

I saw the kiwi in a video and started using it. I showed it to the education guy at my current service and he loves it too. I think we're the only ones.  

Yay for low standards.


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## VentMonkey (Oct 5, 2016)

Handsome Robb said:


> I've never heard of this kiwi grip. Going to have to look it up. I'm sad we don't use DL anymore but with that said I do really like the KV.
> 
> 
> Sent from my iPhone using Tapatalk







I think@DEmedic or someone else may have already posted it, but here it is again. A decent tutorial, too.


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## Handsome Robb (Oct 5, 2016)

VentMonkey said:


> I think@DEmedic or someone else may have already posted it, but here it is again. A decent tutorial, too.



That's pretty nifty actually. 


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## VentMonkey (Oct 5, 2016)

Handsome Robb said:


> That's pretty nifty actually.
> 
> 
> Sent from my iPhone using Tapatalk


Works like a charm with grade 3 DL's, too.


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## Tigger (Oct 6, 2016)

I used it for the first time the other day and it was super helpful for a bad view. Unfortunately, while attempting to move the tube over the bougie, it somehow backed the bougie out and popped into the belly. We recognized it immediately, but I was still a bit unsure of what happened. 

Can you use this and do it by yourself while keeping the view of the tube passing?


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## Handsome Robb (Oct 7, 2016)

Tigger said:


> Can you use this and do it by yourself while keeping the view of the tube passing?



My first thought is no because you need one hand to hold the laryngoscopes, one to advance the tube and one to hold the bougie but I've also never used it.

I've had similar problems with using the bougie in the the past and having it come out because my assistant started to remove the bougie before I actually passed the tube.

Before I moved to my new service I was very selective about who helped me intubate with a bougie for that exact reason. I used to bury the bougie as deep as it would go to try and allow for a margin of error. 


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## VentMonkey (Oct 7, 2016)

Tigger said:


> I used it for the first time the other day and it was super helpful for a bad view. Unfortunately, while attempting to move the tube over the bougie, it somehow backed the bougie out and popped into the belly. We recognized it immediately, but I was still a bit unsure of what happened.
> 
> Can you use this and do it by yourself while keeping the view of the tube passing?


If you're referring to the bougie with the kiwi grip, yes.

Again, the perfect example is a grade 3 view using DL. 

All you see is the epiglottis itself, right?

So once you visualize the epiglottis you drop the bougie in underneath the epiglottis itself, "guide it" if you will.

Once the coudé tip is passed the epiglottis you're essentially in the trachea, the tube should in theory follow directly behind.

If for whatever reason you feel it slipped out, pull back out, suction any secretions, re-bag the patient up, and even try a small blade just to give you more room to move in there the next time perhaps.

I really like the BURP method with 2 providers though, so I always ask for "cric pressure", though it isn't what I mean i just use the term so that once I let go of where I had my hands on the tracheal ring that allowed for the best glottic view, I don't confuse whoever it is I have keeping it in view. 

There's not really much time to explain ELM, and even though you're using a second providers hands, your Jedi skills are guiding them to place their hands where yours were, so in theory you are in complete control of the airway.

Again as a newer advanced provider I understand at times you may feel rushed but give it enough times and you'll see that as you grow more confident this will be exuded, and it will guide your "team" where it is you want them.

Gently, methodically, and confidently (not cocky) are the keys to a sound approach to any airway.

Always have a bail out near by and don't be aftaind to use it. In spite of what any salty "seasoned" paramedic says, this speaks volumes in terms of the level of actual advanced airway provider you are, or aren't. 

Also, this is where "Fred The Head" serves his purpose. I practiced til my technique was spot on where I wanted it; different blades and all.

Good luck, PM me if you have any further questions.


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## jteeters (Oct 7, 2016)

When I was learning to intubate in my Paramedic program (about a year ago), we learned that selection really depended upon provider preference.  However, we were taught the methods to use both, and explained that  the straight blade worked In almost every situation, where the Mac did not.  I prefer the Mac 3 or 4.  Just my preference.  I spend less time worrying about shifting the tongue over, and that little bit of extra time has allowed me to visualize the cords much better.  Just me, though.


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## SeeNoMore (Oct 30, 2016)

I never use the kiwi grip. I find that I have the most control over the bougie when it's not pre loaded. I always have someone (EMT , fire fighter , whatever ) who can take a moment to guide the ett when needed.


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## VentMonkey (Oct 30, 2016)

SeeNoMore said:


> I find that I have the most control over the bougie when it's not pre loaded.


I actually found the opposite to be true for me.
I would rather have said FF,EMT, etc. take over my ELM position whilst I place my airway, different strokes I do suppose though...


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## VFlutter (Oct 30, 2016)

I am a novice at intubating and have not yet decided if I like the kiwi grip. I tend to prefer the bougie straight and "naked" with a Mac / CMAC. Maybe with more practice I will learn to like it. I can see how it would be helpful if you are short on extra hands.


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## StCEMT (Oct 30, 2016)

Chase said:


> I am a novice at intubating and have not yet decided if I like the kiwi grip. I tend to prefer the bougie straight and "naked" with a Mac / CMAC. Maybe with more practice I will learn to like it. I can see how it would be helpful if you are short on extra hands.


At least what little I have played around with it, it does save a little time compared to going with just the bougie. I also like that I have something a little bigger to grip, feel like I have a bit better control.


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## Bullets (Oct 31, 2016)

We learned both in medic school, but when i went to the OR rotation my CRNA was a Miller 4 guy. He told me you can intubate anyone with it and only had a miller 3 on the tray so i basically had no choice. I learned with the miller so thats what i use most of the time. I also use the AA battery sized handle instead of the bigger C sized handle. I feel the thinner handle with the long blade gives me better tip control over the thick handle with the mac.

I also always use the bougie, which was an issue during my truck time as they had been just introduced and most medics thought they were a crutch, whereas we had learned in class with them from the beginning. But screw them, big blades and bougies for everyone


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## VentMonkey (Oct 31, 2016)

Bullets said:


> I also use the AA battery sized handle instead of the bigger C sized handle. I feel the thinner handle with the long blade gives me better tip control over the thick miller with the mac


Unfortunately our service doesn't carry both handles, interesting insight though.


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## TransportJockey (Oct 31, 2016)

Bullets said:


> We learned both in medic school, but when i went to the OR rotation my CRNA was a Miller 4 guy. He told me you can intubate anyone with it and only had a miller 3 on the tray so i basically had no choice. I learned with the miller so thats what i use most of the time. I also use the AA battery sized handle instead of the bigger C sized handle. I feel the thinner handle with the long blade gives me better tip control over the thick handle with the mac.
> 
> I also always use the bougie, which was an issue during my truck time as they had been just introduced and most medics thought they were a crutch, whereas we had learned in class with them from the beginning. But screw them, big blades and bougies for everyone


I love the pedi handle with an adult blade. I'm left handed, so I have the arm strength so I don't need the leverage from the bigger handle, and I do feel I get more fine control with the smaller handle. And I fully agree with a bougie for everyone


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