Thoughts on Blade size

[FireMedic65]

I used a shovel to intubate once before..

but it was an elephant

[P_Instructor]

This scenario reeks of cluster and pucker factor.

Agreed, should be about a 17 on the 1-10 pucker scale, but sounds like they kept their cool and got the job done. When isn't a call like this a 'cluster......'?

[Kaisu]

The intubator gets a point for an effective answer to the issue. (equipment failure aside - it happens but both blades?)

Scooby - do not fall into the trap of bringing chat drama to the forums... and a word to the wise - stay out of drama in this field. There is tons of it and you will get bitten.

[fireflymedic]

I certainly believe you are in a world of hurt if all of your blades between a 0-3 of both Mac and Miller are bad leaving you only the option of a 4. I've seen several times an adult handle used with a pedi blade due to the provider having larger hands, but I can't help but wonder if you checked all your equipment prior to shift. I'm not trying to lay blame or call it afterwards, but eight blades going bad is pretty significant. If that's the case, I'd be having a stern discussion with my employer. You mentioned one was broken due to an over zealous EMT - do you use plastic disposable blades? I'm just curious. If things did go to crap, then you did the best you could, got the job done, and hopefully with very little airway trauma and after effects for the little one. Sometimes stuff just goes sideways .

Hindsight is 20/20 and we can all sit here and say well I would have done this or that, but we weren't there. It sounds like you did the best you could with what you ended up with. Just hopefully it was a learning experience for both you and your partner so it isn't repeated. Did you follow up to see how the little one did? Just curious.

Take care and always be safe.

[VentMedic]

Anybody ever hear of digital intubation for the newborn?

It is much safer than placing something too large and that you have little control over what parts of the soft tissue it will destroy. A baby asphyxiated by blood from a palate tear in not a good thing.

[FireMedic65]

Anybody ever hear of digital intubation for the newborn?

It is much safer than placing something too large and that you have little control over what parts of the soft tissue it will destroy. A baby asphyxiated by blood from a palate tear in not a good thing.

^^^ +10

Apparently my 1 positive feedback I used earlier is all I get for today or else I'd give you one for that.

Anyway, you are 100% correct! I forgot to mention digital in my previous post. Not sure though if you can do that when tracheal suctioning? Please correct me because I was taught in NRP I MUST use a laryngoscope.

[P_Instructor]

Anybody ever hear of digital intubation for the newborn?

It is much safer than placing something too large and that you have little control over what parts of the soft tissue it will destroy. A baby asphyxiated by blood from a palate tear in not a good thing.

Sorry, I'll have to differ from you. Digital intubation of the newborn is not proper. I believe you could do much more damage than using a large blade. At least with the blade, you have the light and visual factors. It is not blind, and in my opinion, would be safer. With some the the providers around here, I would not want them sticking their 'nubbies' in my mouth, no withstanding a newborn. Not enough room. Many human fingers are larger/wider than some of the blades. Proper technique whether large blade or not, should overcome the not visible blind intubation.

Sorry, I guess I should add that if this is the only option to have, then again adapt to the situation and overcome. If you are good at it, go for it. Personally, I feel against digital in newborns, but would do it if I had to.

Edited October 23, 2009 by P_Instructor

[VentMedic]

^^^ +10

Anyway, you are 100% correct! I forgot to mention digital in my previous post. Not sure though if you can do that when tracheal suctioning? Please correct me because I was taught in NRP I MUST use a laryngoscope.

Yes you can suction.

NRP is watered down as in the past it had been 2 full days in length and not just 6 hours. Also, anybody can take it. The nurses and RTs that intubate will have more extensive intubation training than just that course which is not designed to teach neonatal intubation for real situations no more than ACLS was.

Specialty transport and neonatal resuscitation teams are taught all forms of ETI and airway management. We are also taught not to rely on a stylette as just when you need one, it won't be there. Even for meconium babies, we can not always depend on that cute little adapter to be around.

Digital intubation, especially for neonates, had been mentioned in EMS training for many years. I know for adults alternative airways have lessened the need for DI.

Edited October 23, 2009 by VentMedic

[FireMedic65]

Sorry, I'll have to differ from you. Digital intubation of the newborn is not proper. I believe you could do much more damage than using a large blade. At least with the blade, you have the light and visual factors. It is not blind, and in my opinion, would be safer. With some the the providers around here, I would not want them sticking their 'nubbies' in my mouth, no withstanding a newborn. Not enough room. Many human fingers are larger/wider than some of the blades. Proper technique whether large blade or not, should overcome the not visible blind intubation.

Sorry, I guess I should add that if this is the only option to have, then again adapt to the situation and overcome. If you are good at it, go for it. Personally, I feel against digital in newborns, but would do it if I had to.

Guess it depends on the providers hand/finger size. If I HAD to go digital on a newborn, I would my pinkie.

Also what about using a tongue depressor? Cut the finger off a glove if you have to, and hold a pen light in your mouth (had to do this on a trauma patient when my blade light didn't work. Quicker to just whip out the pen light from my shirt pocket. It wasn't perfect, but I had good visual.

Yes you can suction.

NRP is watered down as in the past it had been 2 full days in length and not just 6 hours. Also, anybody can take it. The nurses and RTs that intubate will have more extensive intubation training than just that course which is not designed to teach neonatal intubation for real situations no more than ACLS was.

Specialty transport and neonatal resuscitation teams are taught all forms of ETI and airway management. We are also taught not to rely on a stylette as just when you need one, it won't be there. Even for meconium babies, we can not always depend on that cute little adapter to be around.

Digital intubation, especially for neonates, had been mentioned in EMS training for many years. I know for adults alternative airways have lessened the need for DI.

It was 2006 when I took my NRP and I have not been able to find a recert course, so this this new info to me. I will have to at least get the updated book. Thank you.

We were told not use stylettes in a patient that tiny.

[VentMedic]

Sorry, I'll have to differ from you. Digital intubation of the newborn is not proper. I believe you could do much more damage than using a large blade. At least with the blade, you have the light and visual factors. It is not blind, and in my opinion, would be safer. With some the the providers around here, I would not want them sticking their 'nubbies' in my mouth, no withstanding a newborn. Not enough room. Many human fingers are larger/wider than some of the blades. Proper technique whether large blade or not, should overcome the not visible blind intubation.

Sorry, I guess I should add that if this is the only option to have, then again adapt to the situation and overcome. If you are good at it, go for it. Personally, I feel against digital in newborns, but would do it if I had to.

The difference is you can feel the structures and the mouth giving way as where a cold metal blade could care less. I've seen FFs, RRTs, RNs and doctors with massive fingers master this skill.

Do a little research and pull up some stats from the literature. Some have found DI to be faster and with less failure rate.

It is a shame EMS has also watered down its training for intubation to not include more anatomy, assessment scoring and alternative methods rather than what the latest gadget is.

It was 2006 when I took my NRP and I have not been able to find a recert course, so this this new info to me. I will have to at least get the updated book. Thank you.

As I mentioned, you probably won't find it in the NRP book at it is designed for everyone and does not specifically teach intubation except for an overview as did ACLS a few years ago. I first learned about it 30 years ago in Paramedic school and then learned it again an an RRT doing NICU and transport.

Edited October 23, 2009 by VentMedic