"Standard" Miller size blade?

[norski]

Yup, another airway thread..

An attending of mine and I decided we need to have at least one miller blade in our mac dominated intubation drawers. Standard for all of us in our shop, for any and all adults in the uncharted places (ICU/ER/prehospital) would be a mac 4, styleted or bougie preloaded tube, if that has any importance. VL exists, but we want to expand our skillset. Mac blades aren't that great to pick up the epiglottis with, either. Would you rather have a mil3 or 4 as "the one" miller blade in your cart? Poll attached.

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[David Moss]

Miller 2 and 3 any day of the week!

 

[MirrorTodd]

I would say mil2 is standard.

 

[GassYous]

I'm about a miller 5

 

[Justice4all]

Miller 2. Maybe intubating a giraffe for 3 or 4

 

[IlDestriero]

2

 

[vector2]

2.

 

[teacher2md]

Have you ever used a Miller 4 lol?

No longer than a 3, just huge diameter. I don't see the point.

 

[Arch Guillotti]

2

 

[deleted697127]

Yup, another airway thread..

An attending of mine and I decided we need to have at least one miller blade in our mac dominated intubation drawers. Standard for all of us in our shop, for any and all adults in the uncharted places (ICU/ER/prehospital) would be a mac 4, styleted or bougie preloaded tube, if that has any importance. VL exists, but we want to expand our skillset. Mac blades aren't that great to pick up the epiglottis with, either. Would you rather have a mil3 or 4 as "the one" miller blade in your cart? Poll attached.

Oh yeah. This makes total sense. Use obscure intubation techniques in “uncharted places.” Patient safety. Lmao. Please tell me you guys made some sort of proposal to buy more millers and Bougies for the sake of patient safety for high risk intubations out of the OR rather than buying more video scopes. What did the Miller blade rep give you a lap dance? If I were going to measure length on my CV, I’d say I’m more of a Miller 5 guy. Do private practices care about Miller length?

 

[drmwvr]

I'd ask the question what "one" curved blade would I have in my straight blade dominated cart...that would be a glide...

 

[Endee]

Pulling out a Miller 4:

 

[DrZzZz]

I almost exclusively use a Miller. I use a 2 probably 85-95% of the time, rest I use a 3 for the extra length. Have never needed a 4, but I've also never had to intubate anyone over 7 feet tall. Pic below is a 3 vs. 4.

 

[Guillemot]

for the majority of people miller 2 is fine. Miller 3 in some large men. Miller 4 never needed.

 

[norski]

Edit: 2 is added to the poll.

Also, laughing my ass off at the replies. All are fair. This particular attending has been at it for 30 years, but not once been subjected to a miller the past 25. Me neither(never). Neither of us are using the uncharted territories as practice grounds, but would be nice to have an expanded set of tools with the skills to use them when all else fails. The McGrath is prone to fogging, and the CMAC is a bulky tool to lug around.

Thanks again, you're a wonderful crowd.

 

[deleted126335]

Miller 2 starting at age 2.
Miller 3 for all adults

 

[Gator7]

for the majority of people miller 2 is fine. Miller 3 in some large men. Miller 4 never needed.

Old school cardiac attending here swears by the Miller 4 with howland lock adapter. I use it for fun sometimes and have found it works pretty nicely for DLTs.

 

[AdmiralChz]

Since I find myself rescuing airways, I personally prefer the Miller. I use a 2 almost always unless it’s a big tall person or it isn’t long enough (very rare, has maybe happened twice in the last 2-3 years to me).

There was a trauma that came in after I first started, I asked the CRNA to set up everything including a Miller. It was a Mil 4, and I used it almost as a joke / not sure if it was hazing. The blade was half out of the mouth and felt ridiculous, but it worked. Wouldn’t do it again.

 

[deleted875186]

Miller 2 can intubated almost anyone, Miller 3 too big for all but Larry bird height.

 

[Urzuz]

Miller is my go-to blade and I use a Miller 2 98% of the time.

I don’t think I’ve ever even seen a Miller 4.

 

[Urzuz]

Miller 2 starting at age 2.
Miller 3 for all adults

-1 on both those sizes

 

[coffeebythelake]

I don't use Miller blades

 

[ToKingdomCome]

Is a paraglossal intubation with a Miller worth learning ? Feel like I already know the answer but I’m gonna ask anyway

 

[deleted126335]

-1 on both those sizes

Bigger is better.

 

[norski]

One question revolves in my mind; if the geometry is the same between 2 and 3 until the actual length of the straight section, would a shorter blade actually bring anything to the table, once the decision to bring out the miller has taken place? This coming from a mac environment, where the 3 and 4 are the same size, except for the length( kawe megal7ghts).

 

[DoctwoB]

16oz Miller standard
Some days a 12 is fine
40oz in case of emergency.

 

[Urzuz]

Bigger is better.

But my wife told me it’s about how you use whatever blade you happen to have at your disposal 😕

And something about how guys who use Miller 3s and 4s are all flash with no technique...

 

[Wolverines83]

-1 on both those sizes

miller (preferably philips) 1 until 4

 

[deleted162650]

But my wife told me it’s about how you use whatever blade you happen to have at your disposal 😕

And something about how guys who use Miller 3s and 4s are all flash with no technique...

Funny . . . that’s not what she told me.

 

[pjl]

I am more surprised about MAC 4 being your standard.
I use a Miller 2 or MAC 3 for virtually every intubation.

It takes a very tall man for me to need to upgrade those sizes.

 

[btbam]

Miller 2 is standard, we used to have 4s and would use them just for fun on big teenagers cause they're so comically long and bulky.

 

[IMGASMD]

The only time I used a Miller 4 was right before graduation, on a 18 year old girl.

Pretty sure I cut her lip....

 

[deleted162650]

The only time I used a Miller 4 was right before graduation, on a 18 year old girl.

Pretty sure I cut her lip....

And yet I’m the one with the bad rap for being dirty. . .