The Grandview Blade has been around for many years, but has not gotten the attention other newer tools have. However, it continues to gain wider acceptance and demonstrating that it is better than the older versions.
Obtaining an airway, especially in an emergency situation continues to be challenging. The tongue is often large and floppy. The patient may have secretions, vomitous, or foreign substances in the oral cavity. Depending on the patient, he/she may have an anterior or posterior larynx, or unique airway anatomy. The lighting is also often not ideal, making it more difficult to visualize the larynx or vocal cords.
The Grandview Blade takes all three of these into consideration to make oral intubation much easier. The most common blades used: Miller and McIntosh, have been around for many years and have been the standard. Both have their advantages and disadvantages. However, both are quite narrow and difficult to control the tongue or see the tip or larynx. The Grandview combines those aspects and makes the intubation process much easier. The blade is wider (80% wider) which gives a much wider view of landmarks and makes controlling the tongue much easier. It is tapered so that the portion at the larynx is the same width as the Mac or Miller. The curvature is halfway between the Miller and Mac and conforms much better to the airway, yet still allows good visualization. The blade also uses a patented lamp that is much brighter, making the view even better.
Since it is wider, for best results, I recommend a slightly different technique. After appropriate preparation and positioning of the patient, open the mouth and insert the Grandview blade down the middle of the mouth on top of the tongue (similar to a tongue depressor). Insert about ½ to 2/3 down, then lift up gently. Slowly advance the blade while watching the tip, until it reaches the vallecula and the epiglottis is visualized. Lift straight up while attempting to elevate the epiglottis (like a McIntosh blade). The cords may be visible now. If the patient is older and/or has a floppy epiglottis, it may hang over the cords. If so, then just readjust the tip and place the tip over the epiglottis (like a Miller), lift up, and the cords will be very visible. In other words, in regards to the epiglottis, the Grandview blade can be used like a McIntosh or a Miller.
Any new instrument and procedure requires appropriate training and practice. A pediatric version as well as a disposable version are available. Please review the other articles, power point presentation, and the video training. Research and testimonies are available. But more than that, I have found that once you master this new blade, it will be your first choice for all patients.
Cary Schneider, DO, MPH, FACOEP
Grandview Intubation Blade
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