Miller vs Mac Contraversey!

apaisRN, RN, CRNA · Mar 24, 2006

Miller 4??? My preceptor told me they only have those at the zoo. :rotfl:

MmacFN · Mar 24, 2006

hey

have to admitt, ive never used a miller 4 on anyone. Im a Mac 3-4 or Miller 2-3

gaspassah · Mar 24, 2006

yoga,

i work at a large university hospital with a big tech staff, they do a good job of keeping good batteries, plus we have lots of students that during machine checkouts etc are keen to decreasing battery power as am i myself, i hate it when your batteries start fadiing, so i replace them at the first sign. i like the small handle because it helps me finesse the airway, with the bigger handles you have to grip them with the whole hand and to me this leads to being more "aggressive" with the blades, while the peds handle i can hold more in the fingers and i dont feel like i have to grapple as much. plus it makes minute movements with the tip of the mil blade in the airway easier.

again for those of you who like the miller, give the 4 a try, i think you'll be suprised.

I think that if it works thats all that matters!

you would be suprised to find how many ppl "attendings" "preceptors" who would argue that point. i firmly suggest to students i work with, set up your workstation the way you like it and do the things that make you most comfortable, this is your career and your comfort leads to increased success. (this is for the more seasoned students, not ones who don't have a way of their own yet, they have to start somewhere so why not my way or preceptor way until they find their own way etc.)

heartICU · Mar 24, 2006

Does anyone know the cost of the glide scope? I may consider buying one for the really difficult intubations. When you work alone like I do, one needs to consider back-up equipment.
Yoga CRNA

Yoga,

I am a student at a large midwest program, and we have three or four glidescopes, and use them often in anyone who looks to be a difficult airway. Many clinicians have gotten so comfortable using it, that it is their first choice in an unexpected difficult airway situation. One of the staff physicians at my institution has created a website, and it has a lot of info on its usefulness, video clips showing it in use, where to buy it, etc. His email address is on there as well, so if you have any questions I am sure he would be eager to talk with you about it. I have heard them rumored to be approximately $8000, so they are not cheap, but don't quote me on that. I could be wrong. Here is the website.

www.glidescope.net

MmacFN · Mar 24, 2006

wow

how interesting that there are preceptors who presume to know what will make you the most successful. i teach intubation all the time and my advice is always the same. i show multiple ways to intubate with each blade, tricks and such for difficult airways then i make the same statement

" at the end of the day it doesn't matter how you do it, it matters that you were successful and the patient is ventilated. we are in the

business of getting the tube on the first attempt, anything that helps that is the right way for you."

i dont have to be a crna to know how to tube. on the otherhand, im fully expecting to be forced to do it someone else's way since thats often apart of being a student. as frustrating as it may be!

gaspassah[/left]]yoga,

rn29306 · Mar 24, 2006

Yoga,
I am a student at a large midwest program, and we have three or four glidescopes, and use them often in anyone who looks to be a difficult airway. Many clinicians have gotten so comfortable using it, that it is their first choice in an unexpected difficult airway situation. One of the staff physicians at my institution has created a website, and it has a lot of info on its usefulness, video clips showing it in use, where to buy it, etc. His email address is on there as well, so if you have any questions I am sure he would be eager to talk with you about it. I have heard them rumored to be approximately $8000, so they are not cheap, but don't quote me on that. I could be wrong. Here is the website.
www.glidescope.net

The black and white was around 8K as of last year. The big improvement is the color monitor GS for 10K. Little extra money goes a LONG way. The B&W is good for seeing basic structures, but the color one is simply amazing.

London88 · Mar 25, 2006

I would think that I was about to intubate a horse if you gave me a miller 4. However I felt the same way when I saw a Mac 5 at my workplace. The blade I use depends on my mood. I go back and forth between the Miller and Mac to remain proficient with both. I prefer the view with the Miller but sometimes if the airway is very small it can be difficult to pass the tube. A couple of times I have had to switch to a Mac blade to pass the tube.

jwk · Mar 26, 2006

wow
how interesting that there are preceptors who presume to know what will make you the most successful. i teach intubation all the time and my advice is always the same. i show multiple ways to intubate with each blade, tricks and such for difficult airways then i make the same statement

" at the end of the day it doesn't matter how you do it, it matters that you were successful and the patient is ventilated. we are in the
business of getting the tube on the first attempt, anything that helps that is the right way for you."

i dont have to be a crna to know how to tube. on the otherhand, im fully expecting to be forced to do it someone else's way since thats often apart of being a student. as frustrating as it may be!

somehow i'll bet you'll actually learn some new tricks in anesthesia school that you've never seen or heard of.

MmacFN · Mar 26, 2006

Oh im sure i will!

You can be intubating all day as a full time job and not come up with some nifty tricks! Im excited to see new ideas/ways to do things as well!

maturner · Mar 26, 2006

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

Dave -you're a wild man, you can do my anesthesia anytime.

gaspassah · Mar 27, 2006

lol

Dave -you're a wild man, you can do my anesthesia anytime.

i appreciate the vote of confidence, but dont tell anyone you'll ruin my rep as a slacker! :lol2:

how are things going for you, hope all is well, i may be coming out in august, may try to teach a lecture or do some clinical scenario stuff.

later.

EmeraldNYL, BSN, RN · Mar 30, 2006

Has anyone tried a Bullard laryngoscope? We had an airway seminar yesterday and Dr. Bullard himself was there, it seemed freaking awesome. Although I'm sure intubation would probably be more difficult on a real person than the mannequin was. It looks really similar to the Glidescope that you are all talking about.