Most emergency physicians (EPs) do not find themselves intubating sick children with any routine frequency. However ,when faced with this critical situation, EPs often rely on the Broselow tape to assist with medication dosing and equipment sizing. In some instances, a Broselow tape may not be readily available or the age/weight/height of the patient may be lacking. In these circumstances, it is useful to have a method for rapid selection of the correct Mac or Miller blade to ensure successful intubation.
In an original article published in 2006 in Pediatric Emergency Care, Mellick and colleagues identified a novel technique to estimate pediatric blade sizing using facial landmarks that are easily accessible and adjust with age. This method is analogous to the visual cues for selecting OP and NP airways with which we are quite familiar. A 2-step summary of the method is listed below:
Step 1
Identify the lateral incisor and aim the pediatric blade toward the angle of mandible.
Measure from the base block of the blade to the tip of the blade.
Image Courtesy of Larry Mellick, MD
Step 2
The tip of the blade should be within 1 cm of the angle of the mandible.
If it is too short, select the next longer blade size.
If it is too long, select the next shorter blade size.
Image Courtesy of Larry Mellick, MD
This method was prospectively evaluated by Mellick et al. and the correct estimated blade size with this method was associated with fewer repeat attempts and fewer failed intubations. In this study, the most common error resulting in multiple attempts or failed intubation was use of a blade sized shorter than necessary.
As a validated rapid assessment tool in the emergency physician’s airway armamentarium, the Mellick method may make all the difference when seconds count.
-- Rohith Malya MD
Reference:
Mellick LB, Edholm T, and Corbett SW. “Pediatric laryngoscope blade size selection utilizing facial landmarks.” Pediatric Emergency Care. 2006 Apr;22(4):226-9.
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