# ET Blade Sizes



## adwilcox28 (Jan 16, 2011)

What is good way to remember sizes of laryngoscope blades? And what are some good ways to remember what size blade fits with what size pt....generally speaking of course.


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## usalsfyre (Jan 16, 2011)

adwilcox28 said:


> What is good way to remember sizes of laryngoscope blades? And what are some good ways to remember what size blade fits with what size pt....generally speaking of course.



90% of adult patients can be intubated with a 3 Mac or 2 Miller.


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## usafmedic45 (Jan 16, 2011)

The general rule I use is to measure the same way you do for an OP airway (or to measure from the corner of the mouth to the top of the thyroid cartilage if you can easily see or palpate it).  That will give you a decent idea of the size you need.



> 90% of adult patients can be intubated with a 3 Mac or 2 Miller.



A #2 Miller?  I generally only use that in small adults and large children.  It's often too short to get and hold the epiglottis in most adults.  If I had to pick a "go to" size for the average adult, it would be a #3 Miller or a #3 MacIntosh.

Then again, 90% of people can be orally intubated without a laryngoscope.  LOL


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## MasterIntubator (Jan 17, 2011)

adwilcox28 said:


> What is good way to remember sizes of laryngoscope blades? And what are some good ways to remember what size blade fits with what size pt....generally speaking of course.



Practice and more practice.  It will come... and at 3am, just out of a dead sleep... you reach over without thinking much after taking a quick oral peek.... and it all falls into place.   Goooseflava...


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## Ravemtech (Jan 17, 2011)

Here is a completely different approach for you.  Throw away everything except the Number 4 blade.  Believe it or not, you can use this from newborn to adult.

The Chief Anaesthetist during my training (who was also one of the top recognised Australian Anaesthetists and one of the most experienced in Australia), recomended in the prehospital setting, the Number 4 for everyone.  In his view, in the newborn,  it allows you to better pick up the floppy tongue and gives a perfect view of the cords and faster than a Size 0 or 1. To prevent the blade going in too deep,  3 fingers go on the blade rather than the handle, and the older the child gets, less fingers on blade and more onto the handle. By age 10, all fingers are on the handle. No damage is caused to the airway from the larger blade. 

The theory behind it is that the larger blade of the Size 4, gives greater control of the tongue for all ages, and despite it's size, does not obsure views in any age.  

And as MasterIntubation said,  Practice, and more Practice to develop to technique.

Anyone who is sceptical on how successful this is, please give it a go before canning the concept. From newborn through to adult, you will improve your success rates (and save alot of space in your kit).  This technique has been extremely successful, has improved Paed intubation success rates and/or speed of intubation dramatically by those who use it,  and is really worth trying.


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## usafmedic45 (Jan 17, 2011)

I know a couple of anesthestists who use that technique.  It seems to work for them.  The main thing to remember with airways is that just because it works for someone else or in a particular case previously, it does not mean it will work this time for you.  Always have a backup.


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## Ravemtech (Jan 17, 2011)

usafmedic45 said:


> I know a couple of anesthestists who use that technique.  It seems to work for them.  The main thing to remember with airways is that just because it works for someone else or in a particular case previously, it does not mean it will work this time for you.  Always have a backup.



Hi usafmedic45,

You are right,  what works for some people, does not work for everyone.  The number of different techniques used by Paramedics for IV insertion is a prime example, and it is often a disaster if you try to change someones technique.

The thing about this technique of using the Size 4 blade, is that if correctly taught, it works extremely well.  There have been numerous occassions where numerous Paramedics I was working with failed to intubate the newborn or child with the smaller blades, and in each case was able to easily intubate the patient with the Size 4 blade.  These Paramedics changed their technique to the Size 4 Blade and their success rates increased significantly post teaching and practice.  

The problem with small blades is it takes alot more practice to develop the skills to control the large floppy tongues of the young, and this exposure to real peads just does exist for the majority of Paramedics (manikins do not adequately mimick the real thing), where as the Size 4 requires a simple 'lift up everything' technique that is easier and faster to do.

It may not be for everyone, but everyone I have taught for far in my 16 years as a MICA Paramedic has found it to be a far better technique and improved success and speed of their paed intubations.  

So give it a go, practice the change of technique,  and then see if it works for you.


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## emtech419 (Jan 29, 2011)

Ravemtech said:


> Here is a completely different approach for you.  Throw away everything except the Number 4 blade.  Believe it or not, you can use this from newborn to adult.



Our medical director actually gave us this same advice for intubation with in-line stabilization.  To quote him, "take the 4 miller, bury it up to the handle, and lift.  TADA!"  Although, I think her intended this to be used for healthy adults.


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## NomadicMedic (Jan 30, 2011)

Grandview Blade, FTW.

http://www.youtube.com/watch?v=xURQ12UAcMg


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## usalsfyre (Jan 30, 2011)

n7lxi said:


> Grandview Blade, FTW.
> 
> http://www.youtube.com/watch?v=xURQ12UAcMg



You mean the snow shovel? I found few patients that had a big enough mouth to be effective the year or so I had one available.


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## NomadicMedic (Jan 30, 2011)

usalsfyre said:


> You mean the snow shovel? I found few patients that had a big enough mouth to be effective the year or so I had one available.



Yep. That's the one. Maybe I was just lucky to have large mouthed patients, but the last 3 tubes I placed were with the Grandview blade. It seems to give me all the benefit of a Mac, with better tongue control. It works GREAT in obese patients with a Mallampati >3. I learned about this blade from an anesthesiologist and after tubing some larger, more difficult patients in the OR with it, I was sold.

But, of course, it's all a matter of personal choice. I keep the Grandview loaded on my handle, but have no problem switching to a Mac or Miller if my blade isn't doing the job. I know one guy who tubes EVERYBODY with a Miller 2. :unsure:


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## MasterIntubator (Jan 30, 2011)

Grandview..... that is one sexy blade.. mmmMMMMmmm.


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## usalsfyre (Jan 30, 2011)

n7lxi said:


> I know one guy who tubes EVERYBODY with a Miller 2. :unsure:



Well a 2 or a 3  .


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