Page 192 - Clinical Application of Mechanical Ventilation

158 Chapter 6

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Miller blade: A straight
laryngoscope blade. It lifts up the
epiglottis for visualization of the
vocal cords during endotracheal
intubation.

MacIntosh blade: a curved la- Figure 6-5 A conventional laryngoscope with a Miller blade (left) and a Macintosh
ryngoscope blade. Its tip is placed blade (right).
at the vallecula and indirectly lifts
the epiglottis for visualization of
the vocal cords.

In addition to the intubation supplies, proper airway management also requires
The laryngoscope handle
is held by the left hand. oral airway, nasal airway, oxygen supply, and resuscitation bag/mask system.
Laryngoscope handle. The laryngoscope handle contains batteries and it allows at-
tachment and manipulation of the blade during intubation. Figure 6-5 shows a
Laryngoscope blades laryngoscope handle with a Miller blade and a Macintosh blade.
range from size 00 for small The laryngoscope handle is held in the left hand since all standard blades attached
preemie to size 4 for large
adults. to the handle are designed for right-hand intubations.
Blade. The laryngoscope blade attaches its flange onto the post of the handle
(Figure 6-6). Once snapped into position, the built-in light source at the distal
A straight blade lifts the end of the blade comes on. A laryngoscope blade is either straight or curved
tongue and epiglottis upward and ranges from size 00 (small preemies) to 4 (large adults). Size 3 blades are
to expose the vocal cord and
related structures. intended for most adults. The straight blade (Miller blade) is used to lift up the
epiglottis during intubation. The curved blade (Macintosh blade) is placed in
an area called vallecula, and indirectly lifts the epiglottis for visualization of
the vocal cords.
A curved blade lifts the
tongue only. The basic technique of intubation is the same no matter which type of blade is
used. The primary difference between these two blades is that a straight blade lifts
the tongue and epiglottis upward to expose the vocal cords and related structures
(Figure 6-7). The epiglottis is not visible when a straight blade is used correctly. The
vallecula: An area between the
base of the tongue and epiglottis; tip of a curved blade rests at the vallecula (between base of tongue and epiglottis)
an anatomical landmark for the and lifts the tongue only (Figure 6-8). The epiglottis may be seen through the mouth
placement of the curved blade.
when a curved blade is used correctly.

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