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Miller vs Mac Contraversey!



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Mar 22, 2006 08:43 PM

Miller vs Mac Contraversey!

by MmacFN

Ok all

So i decided i would ask and see what everyone seems to like and why.

I use both equally well ( I attribute that to one CRNA and one MDA for forced me to tube everyone one day with a miller ;P). However, i have a prefrence depending on the patient.

Mac

- Standard adult intubation No cspine

Miller

- Anterior airway
- Short thick neck
- Pediatrics (pick up the epiglottis)
- ANY C-Spined pt.

Anyone else? Whats your preference? Why?


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26 Comments
No. 1
from jwk
Old Mar 22, 2006, 09:50 PM

Default Re: Miller vs Mac Contraversey!
Originally Posted by MmacFN
Ok all

So i decided i would ask and see what everyone seems to like and why.

I use both equally well ( I attribute that to one CRNA and one MDA for forced me to tube everyone one day with a miller ;P). However, i have a prefrence depending on the patient.

Mac

- Standard adult intubation No cspine

Miller

- Anterior airway
- Short thick neck
- Pediatrics (pick up the epiglottis)
- ANY C-Spined pt.

Anyone else? Whats your preference? Why?
Mac of course.

Interesting you would choose a straight blade for C-Spines - I think you minimize movement better with a Mac.

If you really want to see well, try a Glidescope, essentially a Mac blade with a TV camera at the end - awesome view, NO neck movement. We've actually used it instead of FOB on a couple of patients including C-spines. Loved it.
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No. 2
from MmacFN
Old Mar 22, 2006, 10:12 PM

Default Re: Miller vs Mac Contraversey!
Hey

Yes the reason i use a miller as opposed to a mac has more to do with the decrease in visibility with the mac due to the curve of the blade. Hold 2 of them side by side where the connecting point of the blades are level. Turn them to the side. You notice a .5 cm difference (or so) in how far the curved blade obscures the view. In my experience the less i have to manipulate the better, with .5 cm in the difference looking straight down the blade i find i lift less, a technique taught to me by an MDA here. Works well!

The glidescope is cool, but has no place in pre hospital. Sadly, a bloody airway ruins it Ive played with it on a couple occasions in the OR and was amazed. Do you use it all the time or is it just a toy for here and there?
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No. 3
from rn29306
Old Mar 22, 2006, 10:18 PM

Default Re: Miller vs Mac Contraversey!
Use MAC almost exclusively.

The Miller partially obscures the view by nature of it directly lifiting the epiglottis, for me at least. Tongue control is obviously harder with the Miller. I guess it is what I have gotten used to.
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No. 4
from sonessrna
Old Mar 22, 2006, 10:56 PM

Default Re: Miller vs Mac Contraversey!
I LOVE the MIller. BUt there are definitely times where I can't see with the Miller. I feel pretty competent with both, but sometimes it just depends on the patient. Small mouth opening, probably a MAC for me. C-spines, I usually just go to the FOB. Trauma, MAC and inline stabilization. ANyway...that's me.
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No. 5
from MmacFN
Old Mar 22, 2006, 11:09 PM

Default Re: Miller vs Mac Contraversey!
good points all!

Funny how everyone is different isnt it? There is no answer except "whatever gets the tube in"

Its fun to debate though.
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No. 6
from yoga crna
Old Mar 23, 2006, 08:05 PM

Default Re: Miller vs Mac Contraversey!
Miller 2 blade, MAC computer.
Yoga
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No. 7
from GCShore
Old Mar 23, 2006, 08:19 PM

Default Re: Miller vs Mac Contraversey!
Originally Posted by yoga crna
Miller 2 blade, MAC computer.
Yoga
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No. 8
from MmacFN
Old Mar 23, 2006, 08:29 PM

Default Re: Miller vs Mac Contraversey!
hehehehhe
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No. 9
from gaspassah
Old Mar 23, 2006, 08:38 PM

Default Re: Miller vs Mac Contraversey!
well you'll probably look at me strange like everyone else but i like the small pediatric handle with a miller 4 blade, i intubate 99 percent of my patients like this. if you like a miller blade try a mil 4, you get almost the same if not more exposure than a mac, but all the miller attributes. and yes i use it on little old ladies too.
d
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