Thoughts on Blade size

[JakeEMTP]

NRP is one class I haven't taken yet but am planning to. I must admit, I never considered using a DI in a infant. It does make sense though. After doing a search the information is favourable in doing so.

This is why I keep coming back to the City. The information you learn here is endless.

[scubanurse]

Maybe I did misunderstand, but regardless this is a good discussion to have.

Kaisu...I very rarely bring chat discussion into the forums and do my best to stay out of drama, but I felt that this was a good topic to discuss, so I brought it over here.

It just surprised me when I came into the chat room and read that this person used a Mac 4 for every intubation. Questioned further I became concerned that a Mac 4 was being used on an infant. If I did not get the entire story, I apologize but the situation because heated rather quickly and I decided to step out to not cause drama. Regardless, I think this is a pretty good discussion of how to adapt when equipment fails.

So we all agree, that a Mac 4 should only be used in a last ditch effort to intubate. Personally, I would probably attempt digital intubation or use a small OPA to lift the jaw than use a large blade. I don't have one here in my hands, but from memory the Mac 4 has a pretty wide blade to support the size of an adult tongue and jaw, most newborns mouths are not very big, I would have a hard time visualizing the cords. But that's just me.

As far as equipment failure, the only time I have seen a laryngoscope blade break was someone dropped it, or stepped on it. Those things are pretty tough in my experience. Checking your equipment before each shift should include checking the bulbs of every blade and making sure you have at least one of each size blade, if not more. I understand things can malfunction at anytime but we can minimize this by maintaining our equipment with regular maintenance and various other steps.

Again sorry to have people all in an uproar at me, not my intention with this post.

[Lone Star]

I feel kind of responsible for this entire thread....I AM after all, the one that came into the chat room and asked a question about the sizing of laryngoscope blades.

Here's the entire 'back story' to this thread:

I came home from class all hyped up because I finally got to 'play' with a laryngoscope (on a mannequin) and was able to ‘drop a tube’ in less than 10 seconds from the time the OPA and BVM were removed.

A lot of emphasis was placed on how I HAD to hold the laryngoscope in my LEFT hand and the ETT in the right hand. Being a 'lefty', I automatically grabbed the ETT with the left hand so that I could use my 'dominant hand' for better control in placing the ETT.

As we were 'getting the feel' of assembling the laryngoscope (changing blades, etc), I noticed the length differences between a #4 Miller and #4 Mac Intosh blade, and asked in the room about how one would select the appropriate size of blade for visual intubation.

This is where it all went to hell in a hand basket. I didn’t mean to start a war here!

*Side Note* I realize that tubing a mannequin is MUCH different than intubating a 'real person', but I was jazzed up that the first attempt at ever getting to 'play' had such good results. Now you know 'the rest of the story'! (+1 for the first person that can identify the person who made that last 'quote' famous)

LS

[FireMedic65]

NRP is one class I haven't taken yet but am planning to. I must admit, I never considered using a DI in a infant. It does make sense though. After doing a search the information is favourable in doing so.

This is why I keep coming back to the City. The information you learn here is endless.

NRP is a good class. Very informative and all that. But pretty much the most I got out of it aside from what I already learned about neonates, is the resuscitation sequence is different.

[JakeEMTP]

NRP is a good class. Very informative and all that. But pretty much the most I got out of it aside from what I already learned about neonates, is the resuscitation sequence is different.

Thanks 65! After I recert in ACLS, PEPP and ITLS at the end of November, I'll start looking for a NRP class.

[FireMedic65]

Thanks 65! After I recert in ACLS, PEPP and ITLS at the end of November, I'll start looking for a NRP class.

They are hard to come by actually. My course was taught during medic school by nurses from the one hospital who did it as a favor to our lead instructor.

If you are having a hard time finding one, I would suggest contacting your hospitals that have OB/GYN department.

[fireflymedic]

If you have a children's hospital nearby, they are usually very proactive in teaching NRP. There are three around here that offer it during EMS week yearly.

As far as digital intubation, my fingers are quite large and I know that even within a patient that had a fairly large mouth there isn't as much room as one would like. In the mannequins I can barely fit my middle and index finger in to drop the tube between. I am fortunate in that I've never been at the point of last resort with a patient that I would use it. Always had other options to revert to. Not to say there isn't a place for it, just is a bit more difficult. I think digital intubation would be more difficult on a pedi due to that as well as the fact you could really only place (for most people) your pinky, perhaps fourth finger in to lift up and you don't have a track for the tube to follow down. If you didn't use a stylet, I can imagine it would be extremely difficult IMHO.

[VentMedic]

If you have a children's hospital nearby, they are usually very proactive in teaching NRP. There are three around here that offer it during EMS week yearly.

As far as digital intubation, my fingers are quite large and I know that even within a patient that had a fairly large mouth there isn't as much room as one would like. In the mannequins I can barely fit my middle and index finger in to drop the tube between. I am fortunate in that I've never been at the point of last resort with a patient that I would use it. Always had other options to revert to. Not to say there isn't a place for it, just is a bit more difficult. I think digital intubation would be more difficult on a pedi due to that as well as the fact you could really only place (for most people) your pinky, perhaps fourth finger in to lift up and you don't have a track for the tube to follow down. If you didn't use a stylet, I can imagine it would be extremely difficult IMHO.

You can crook and hook one finger to tube a baby.

I don't recommend DI for pediatrics because they have "teeth". If they awaken during intubation you will think a shark has taken your fingers. Adults, I have used a tongue depressor to assist in a frontal intubation if there wasn't room to maneuver a blade and handle.

Everyone should not allow not having a stylet stop you from intubating and should be confident in your skills if you didn't have one especially for neo/peds. Just try not to keep the tubes in the warmest part of the truck. Also, if given the opportunity to intubate in neo/peds, don't place the tube under the warmer while getting into position.

I guess one of the arguments with the whole ETI situation is that some don't utilize all of their options. Whatever you have in your tool box or your hands, you should be proficient at. That includes the BVM and all the alternative airways. Of course, for neonates, one would have to sink an OG if using the BVM for a prolonged time.

Edited October 23, 2009 by VentMedic

[FireMedic65]

I think you forgot something vent

[VentMedic]

I think you forgot something vent

Yeah I double clicked on the reply button.

Still getting used to this new site and I don't like the center default.