# Miller vs Macintosh



## Sizz (Sep 24, 2010)

Which blade do you prefer to use?

Honestly as a Medic Student as we are going through the airway section I'm having better luck with the Mac.


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## Lifeguards For Life (Sep 24, 2010)

depends on the airway. Become proficient with both.


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## MasterIntubator (Sep 25, 2010)

Mac 3/4 is my old standard.  But since the grandview blade, I rarely look back to others.


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## akflightmedic (Sep 25, 2010)

I really do not see it as a preference. 

You have to use whatever is most appropriate for the patient based on your assessment, therefore my preference is irrelevant.

I hear ya on the grandview though!!


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## MrBrown (Sep 25, 2010)

Which blade do I use? I perfer my machete! 

Now, as to them damn fangled airway bits and pieces bah .... simplicity is key, whip out an LMA, shove it down thier gob and blow up the cuff!

Should one require a bit more, call for an RSI trained ICP or Doctor


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## sir.shocksalot (Sep 25, 2010)

I typically use a miller 4 as it seems to fit everyone and I seem to be a little better at finding the cords with it. But as Lifeguard says, become proficient with both as sometimes a mac works better than a miller, that and sometimes someone has taken all of the lights off the miller blades because "no one uses them anyway" :glare:


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## Smash (Sep 25, 2010)

Mac 4 seems to be my go to blade at the moment, but I carry millers and use them as well.  I've not used a grandview, would like to.  We use metal single use ones, and have no autoclave facilities, so that inhibits my experimentation with blades.


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## usalsfyre (Sep 25, 2010)

If I am not influenced by other factors and have my choice, it's a 3 Miller. I feel it gives superior control. However, be proficent with both blades, as they both have their uses.


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## johnrsemt (Sep 25, 2010)

I always had better luck with Millers on Peds, and Macs on Adults;  but was good with both,  and I had been known to use 4 different blades on a difficult airway.


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## LondonMedic (Sep 25, 2010)

Over here Macs are almost universal for adults, consequently all my experience is with a Mac 4.


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## Shishkabob (Sep 25, 2010)

*Whistles innocently*


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## Sizz (Sep 26, 2010)

*Thanks for the replies*

Thanks for the posts, I just generally wanted to see what most people would prefer if the if the patients were anatomical similar in the airway and you could use either or blade..which would you grab first. 

I'm learning so I'm not an expert or even close and do realize a Miller is better fit than a Mac and as well as the Mac is for others just in some blades fit some but not others seems to be pretty much common sense. 

Anyways thank you for the replies.


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## MasterIntubator (Sep 26, 2010)

Thats good.  You should strive to find out the latest and greatest... try it... and make your own assessment based on your experience, and go with that.
I would venture to say most folks here.... probably have numerous options ready at their side if the #1 first choice fails. 
And from experience.... it should not take long at all to switch up if for some reason your 1st choice fails.  You should be able to switch blades in 3 seconds or less once the failed blade comes out of the yap.  Be mindful of your equipment set up.... all my stuff is about an arms length away at about 45 degrees on my right.... tubes, blades, tape, toys and stuff.  So if something does go wrong.... its there.  If you got a vis on the chords.... never look away, know where your stuff is, and use your peripheral vision to guide you and always keep those chords in view. 

I love to see proactive actions..


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## usalsfyre (Sep 26, 2010)

You can ususally tell the folks who intubate a lot. Airway equipment gets checked closely in the AM, including the portable suction, and when it's time to actually pass a tube things tend to get layed out very similarly to what MasterIntubator describes.


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## EMS49393 (Sep 26, 2010)

I don't get the opportunity to intubate very often in my extremely slow area.  When I did do it frequently, I loved the grandview for most adults.  When I moved here, they didn't have the grandview and I went back to a Mac 4 in most adult cases.  

Since I don't get to use this skill often and can't seem to get anyone to realize how important it is to practice and help me get some OR time, I've resorted to back up devices on my last two codes.  If I get in there with a blade and can't see, I don't even screw around.  I get out and use a King LTD, which is my only available back up device.  I know if a patient can be ventilated with a BLS adjunct that they don't require rapid airway intervention in these instances, but both patients were grossly obese and difficult to bag making airway one of my priorities.  

I'd love to be as good as I used to be, but without practice, I just can't keep it up.  I'm not going to do further damage by jacking around when I can easily insert a back up device.  Those little doclings in the ER have more tubes then I do this year, I guarantee it.


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## TransportJockey (Sep 26, 2010)

Mac is my favorite, but in school I got used to both, so it really doesn't matter to me


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## aewin90 (Sep 26, 2010)

Linuss said:


> *Whistles innocently*


I take it you prefer longswords?


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## omak42 (Sep 28, 2010)

If I have to choose between Miller and Mac I would choose Miller, only because I usually feel like I have a lot more room to work with.  Then again, the last agency I worked for didnt give me the option, as they only provided Millers   I dont find I am any more proficient with one of over the other however.


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## 18G (Sep 28, 2010)

I have limited intubation experience so its hard to state an absolute preference but I have used the Miller more than the Mac and for me I had good results. To get under the epiglottis and directly lift it seems a bit easier. But again, the more intubations I do my view may change. 

With peds I was taught to use a Miller since the epiglottis is floppy and may not lift well indirectly with a Mac.


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## FDNYRescueMedic (Oct 7, 2010)

In-line ETI for c-spine I go with a Miller, everyone else (adults) get a Mac 4.


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## curt (Oct 10, 2010)

Always have preferred a miller blade.


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## himynameismj (Oct 15, 2010)

i intubated for the first time today. nailed each one, only popped the teeth on my very first one. after using both, i had to say the miller 3 tickled my fancy. it just says, "hey you, yeah you.. epiglottis. get out of my way. right.. the f%#k.. now". brutal.


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## Smash (Oct 15, 2010)

himynameismj said:


> i intubated for the first time today. nailed each one, only popped the teeth on my very first one. after using both, i had to say the miller 3 tickled my fancy. it just says, "hey you, yeah you.. epiglottis. get out of my way. right.. the f%#k.. now". brutal.



I'm sure the patient appreciated the dental trauma...
Intubation should be the opposite of brutal. If it's brutal, something has gone wrong.


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## himynameismj (Oct 15, 2010)

Smash said:


> I'm sure the patient appreciated the dental trauma...
> Intubation should be the opposite of brutal. If it's brutal, something has gone wrong.



The pt was a plastic mannequin. I'm a student, just started. But yeah, after the first try I realized force doesn't win those battles.


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## TacoMEDIC (Oct 22, 2010)

MAC 3-4 everytime (excluding peds, of course)


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## fast65 (Oct 23, 2010)

So far I've had pretty good luck with both of them, at this point I really can't say I prefer one over the other


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## swissmedic (Oct 29, 2010)

I am working in EMS over 14 years and the anesthetics department for 7 years. So I prefer for any adult pt. the macintosh size 5 & for pediatric I use a miller size 2.
You will find out your own favorite...
Matt


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