For many years the world of EMS Laryngoscopes has been a “flat earth”, with only two basic blade styles to choose from. Ask most Paramedics about Laryngoscope Blades and they will usually only know about the MacIntosh & Miller Blade Styles. But there are many more available, some which have unique advantages for EMS Providers. I’ll describe a few of the better EMS Laryngoscope Blade Styles. Each one offers an improved view with fewer complications. They can help make your job of performing endotracheal intubation under challenging conditions easier and safer. First, the Straight Blades;
The Cranwall is a modification of the Miller that retains the extended curved tip to facilitate in lifting the epiglottis. The Cranwall™ blade has a dramatically reduced flange to allow insertion through a restricted opening and decrease potential for damage to the upper teeth. Very useful with C-collared patients or those with facial burns.
WHITEHEAD WISCONSIN Blade
The Whitehead is a modification of the wide Wisconsin blade. It has a reduced flange to increase visualization, facilitate intubation and reduce possibility of damage to the incisors.
This blade is for infants and children. It is gently curved over the distal third and is designed to lift the epiglottis indirectly in the manner of the MacIntosh blade. The blade section permits binocular vision thus allowing better judgment of depth and consequently less risk of trauma.
Now the Curved Blades;
BIZZARRI-GIUFFRIDA Blade or FLANGELESS MAC
The Flangeless Mac is a modification of the MacIntosh blade with the upper flange removed. This blade is especially well suited for use in patients with a limited mouth opening, prominent incisors, receding mandible, short thick neck or having the larynx in an extreme anterior anatomical position. The absence of the flange greatly reduces the chance of trauma during laryngoscopy.
REDUCED FLANGE E-MACINTOSH
The RF E-Mac is a modification of the “English” Profile laryngoscope blade. Reducing the flange will enable the user to exert less force upon the maxillary incisors. For those unfamiliar with the E-Mac, it is a lower profile version of the traditional curved blade. In many parts of the world they do not even use straight blades. The E-Mac is low profile (flat) enough you don’t need them. You just enter the posterior pharynx if you want to directly lift the epiglottis, and enter the anterior pharynx and slide the blade along the tongue if you prefer the indirect approach.
Any of these choices will help you protect teeth from harm, and dramatically increase your viewing area. The sad part of this issue is that none of these blades are really new. Most have been around for many years.
There are two more blade styles worth consideration, the Rusch Viewmax & the Hartwell Grandview blades. The Viewmax has a patented lens system that refracts the image approximately 20° from horizontal, allowing visualization of even the most anterior larynx. The exclusive lens system also provides visual confirmation of endotracheal intubation by allowing a clear view of the vocal cords even as the tube passes through. One of the neatest things about the Viewmax (for us older Medics), is that if you normally need readers to intubate, you will be surprised that you don’t need your glasses with a Viewmax. Some of the most respected names in EMS use the Viewmax, like the ESU guys in NYC, and even the President of NAEMT, Ken Bouvier, carries one. The Viewmax is available in two sizes, and both standard bulb & fiber optic versions.
The Grandview offers a very wide, flat surface. While I don’t personally care for the tall sidewall height, the Grandview is still light years ahead of the old Miller Blade. It is also available in two sizes, which thanks to this blades design is about all you will ever need.
The flanges that get in your way with standard blades are there for no real reason at all, other than to obstruct your view. They have flanges because 50 years ago laryngoscope blades were frequently made of nickel-plated brass, a soft metal. They needed the flange back then for linear reinforcement. But they have been making laryngoscope blades out of stainless steel since the 60’s – and these structures are no longer necessary. The plain truth is they keep making them this way because that is the way they have always been made.
Before you consider less desirable alternative airway devices, consider upgrading your basic, fundamental tools of laryngoscopy. You will be very glad you did the first time you use any of these blade styles.