Procedure Tips

The C-MAC

The c-mac is a video laryngoscope. It consists of a video screen and several attachments, only one of which can be used at a time. Ours has 5 attachments.

  • A larger camera for adult sized blades.
  • A smaller camera for pediatric blades
  • A bronchoscope
  • A nasopharyngoscope
  • An intubating stylet

This is a great tool for learners, because unlike the Glidescope, the Mac 3 blade feels very much like macintosh laryngoscope. It gives a realistic direct laryngoscopy experience for the provider doing the pocedure, but also allows the attending (and everyone else in the room) to see exactly what the intubator sees. That not only adds to patient safety, but also allows for real time instruction.

The blades are disposable, and should be found in the drawers on the cart. We keep 2 adult sized blades: a “Mac 3” and a “D-Blade.” The Mac 3 feels like a number 3 macintosh laryngoscope and has the same shape. The D-blade, on the other hand is hyperangulated, and using it will likely require a rigid stylet. The stylet should be in the drawers as well. The images are recordable and can be saved on the device itself. Below there are images of all of these as well as a clip of an intubation done using the Mac 3 blade.

Proper sterilization after uses has been an issue in the past, and that protocol will added here shortly.

video assisted intubation using the mac 3 blade on the c-mac

“Nerve block needles”

The brand name here is Stimuplex. These come in very handy for blocks done near vascular or other sensitive structures. They allow you to have your hand on the needle, rather than ackwardly holding a syringe with a needle on it. This is a “hand-on-needle” technique as opposed to a “hand-on-syringe” technique. It does require an assistant to push the plunger as both of the operator’s hand are busy: one holding the ultrasound probe, the other directing the needle.

Another nice thing about them is that the needle has a blunt tip. This not only adds safety in that it is less likely to damage a nerve that in inadvertently jabbed, but also makes for a palpable ‘pop’ as tissue planes are traversed – something much more subtle with sharp needles.

Notice there is a an extra wire hanging off the needle. This is to be plugged into a nerve stimulator. We don’t use nerve stimulators for ultrasound guided regional anesthesia, so this extra wire is superfluous for our purposes.