Curved vs. Straight blades

[Carlos Danger]

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?

 

[VentMonkey]

View attachment 3042 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.

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.

 

[Handsome Robb]

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]

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.

 

[VentMonkey]

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

 

[Handsome Robb]

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]

That's pretty nifty actually.


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

 

[Tigger]

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?

 

[Handsome Robb]

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]

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.

 

[jteeters]

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.

 

[SeeNoMore]

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.

 

[VentMonkey]

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...

 

[VFlutter]

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.

 

[StCEMT]

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.

 

[Bullets]

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

 

[VentMonkey]

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.

 

[TransportJockey]

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