MAC VS MILLER FOR ETI

MACINTOSH
MILLER

For the last few months and even during Paramedic class i fell in love with macintosh blade for intubation and that is how my many intubations in the last 16 months have been until today. The mac blade is a fantastic tool but with most things in EMS we are taught that things especially that medicine is not black and white it is gray. This means that things are never the way they are in the text books like every tool there is a time and a place and today there was certainly a tool for the job. Macintosh blades are fantastic and they serve there purpose and in most cases are great until you get a pt with a very small oropharynx. This pt's mouth was as wide as a mac and i knew that it would never work i even picked up a smaller blade than i was going to use and it was still as wide as his mouth so i knew that i was dead in the water with the mac. So i had to do what every good Paramedic would do and i changed something i grabbed the miller 3 i had never used one on a live pt so i put it on the light was bright white and tight and i selected the proper tube that i had already pulled out and it was all set to go and i had my back up airway out and suction under the right shoulder and on. So we were all set to go so i then put the laryngoscope in his mouth sweeping right scooped the tongue and swept left and buried the blade in the esophagus and started to pull back and there it was. A text book picture of the vocal cords nice and white. I grabbed my ETT and slide it in paced the black marks and inflated my cuff and began to ventilate with += chest rise and fall and + moisture in the tube with present upper and lower breath sounds bilaterally with negative epigastric sounds placed my capno on the tube with a beautiful capno wave and good readings on the monitor. This intubation couldn't have gone smoother. I then secured my tube with a tube holder and rechecked lung sounds airway secured. So again this is up to the AlS techs decision but there is a time and place for tools and sometimes we have improvise, adapt, and overcome for the best outcome for the pt's that we care for. This is not only for intubation this goes for many things. As a Paramedic it is your job to make sure that the pt is getting the best care at the time of the call not only do you have to worry about you are doing you also have to worry about everything that is going on at the scene of that call and make sure that it is under control while you are also trying to save the life of the person and there family friends and loved ones that are relying on you to save them. This is why making sure that you have the proper equipment and make sure all equipment is in working order before every call. This part is not just that of the ALS tech but the BLS tech as well is the BLS equipment ready to go. BLS before ALS you cant save someone without BLS first.