Thoughts on Blade size

[scubanurse]

So an interesting "debate" popped up in chat. Someone stated that they use a Mac 4 for every patient including a newborn. I have a hard time believing that this is a safe practice, they argued otherwise.

What are y'alls thoughts on the use of a Mac 4 for the ETT intubation of a newborn?

[flight-lp]

Stupid comes to mind..............

[scubanurse]

yeah... but stupid aside... what kind of damage could be done to a newborn if intubated with a mac 4?

[Dustdevil]

Damage would be more a result of the aggressiveness of the user than the size of the blade. And that would be the same damage you can cause to any patient, although cord damage would certainly be less likely. I suspect that a practitioner with experience and finesse, and steadier hands than me, could pull it off in a pinch without any damage. I don't know of anyone who would try, or any reason why they might, other than the aforementioned stupidity.

[EMS49393]

Damage would be more a result of the aggressiveness of the user than the size of the blade. And that would be the same damage you can cause to any patient, although cord damage would certainly be less likely. I suspect that a practitioner with experience and finesse, and steadier hands than me, could pull it off in a pinch without any damage. I don't know of anyone who would try, or any reason why they might, other than the aforementioned stupidity.

The entire thread is directed at me. Thanks for chiming in. I'll give you the reason why a seasoned practitioner with steady hands that did pull it off without damage in a pinch had to try it... Necessity. I was in a situation with nothing else at hand at a complicated delivery with multiple equipment failures. I absolutely had to suction meconium, which requires intubation, and I had two successive blade failures, one a bulb and the other broken by an overly anxious EMT.

Scooby didn't get the entire story before she began to flame me and call me a baby killer. You can Monday-morning quarterback all you want, but when you're knee deep in a big pile of suck, you make do and improvise.

I might be stupid, but that kid is alive.

[Dustdevil]

I don't know of anyone who would try, or any reason why they might, other than the aforementioned stupidity.

Let me clarify that to say, I don't know of anyone who would ELECTIVELY try. In a pinch, you gotta do what you gotta do, and there are a lot of pinches in EMS. I thought we were talking about someone who uses a #4 on everyone, regardless of size, just for the Hell of it. I'd darn sure rather it be a Miller though.

Edited October 23, 2009 by Dustdevil

[spenac]

I'm with Dust if things go to heck and I don't have a working 0,1,2,3 and have to go with a 4 I would prefer the miller for that in a pinch situation.

Now I have to ask EMS did you check your equipment at the start of that days shift?

[FireMedic65]

Let me clarify that to say, I don't know of anyone who would ELECTIVELY try. In a pinch, you gotta do what you gotta do, and there are a lot of pinches in EMS. I thought we were talking about someone who uses a #4 on everyone, regardless of size, just for the Hell of it. I'd darn sure rather it be a Miller though.

Well said. I was not present for the chat debate so I do not know the whole story. Would I use a Mac 4 on a newborn? Most likely not.

With 2 blade failures prior to trying the 4 blade, what other blades do you carry? Equipment does fail but should be checked before every shift. Equipment does break but not quite that easy. What other blades do you carry? Our kits have A large variety of sizes for adult and pedi. Miller 0-4 and Mac 1-4 with adult and pedi handles. Surely there had to be a smaller blade to use, but who knows.

Regardless, I was not there. I do not know the situation you were in, I do not know what you had to work with.

Glad to hear things turned out well for the kid though.

yeah... but stupid aside... what kind of damage could be done to a newborn if intubated with a mac 4?

Damage that "can" be done may vary from NONE to death. It depends on the person using it. If you just need to lift the jaw out of the way to see the cords and suction, while not putting it all the way in to the vallecula.

I will have to get out the airway manikins and try different size blades on the infant ones just to see what "I am looking at" The size of the blade and the small mouth/airway might be obstructed.

[P_Instructor]

Whether deemed appropriate or not (I believe this is why there are different blade sizes), it looks like what happened, happened to the circumstance. The job was done. Many times comes the addage that I will stand by:

Identify, Adapt, Overcome.

You don't do what you need to (in certain circumstances) and the patient suffers/dies. The outcome was, you got what you wanted done.

[Just Plain Ruff]

Whether deemed appropriate or not (I believe this is why there are different blade sizes), it looks like what happened, happened to the circumstance. The job was done. Many times comes the addage that I will stand by:

Identify, Adapt, Overcome.

You don't do what you need to (in certain circumstances) and the patient suffers/dies. The outcome was, you got what you wanted done.

This scenario reeks of cluster and pucker factor.

If you have to adapt then by all means you do what you have to do to save the patients life. I would also use a 4mac if it was the only blade available but I'm not gonnna be happy.

Unfortunately this also sounds like a miscommunication by the original poster. Sorry Scooby but it doesn't sound like you got the whole story before you came here and posted.