Response to difficulty: Use Mac Like Miller

When indirect control of the epiglottis and laryngeal exposure proves difficult by the traditional Mac blade approach of placing the blade tip in the valleculae, consider repositioning the blade like in Miller blade technique to directly lift the epiglottis.

That is how you will deal with an epiglottic cyst or tumor should you encounter one. It may also be helpful should the epiglottis be swollen and immobile. In addition, lingual tonsillar hypertrophy will not allow the epiglottis to lift normally by indirect means. A particularly large and floppy epiglottis will also have difficulty with control by indirect lift (e.g. in pediatrics). Finally, if one cannot seat the blade properly in the valleculae due to limited mouth opening or large dentition restricted blade movement, then a direct lift of the epiglottis may work. Starting with the longer Mac 4 blade is helpful as it gives you these options without the need to switch your blade during your first attempt.

Be aware of the other responses to difficulty like external laryngeal manipulation when encountering poor laryngeal exposure and challenges in controlling the epiglottis.

Here is an example of where direct lift of the epiglottis allowed laryngeal inlet exposure for the intubation using indirect/video laryngoscopy.

Advertisements

One thought on “Response to difficulty: Use Mac Like Miller

  1. Pingback: Response to difficulty: Use Mac Like Miller | Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s