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c-mac

C-MAC

  • Karl Storz video laryngoscope
  • Interchangeable blade system with screen recording to SD card
  • Flexible nasendoscope component for airway assessment
  • Hyperangulated “D-blade” for trauma intubations, anterior larynx, decreased mouth opening

Set-up

  • Select the size 3 or size 4 Mac blade for the typical adult intubation
  • Take care plugging the blade handle onto the cable block - damage to components has occurred
  • Switch screen on using power button
  • May choose to run the device off battery to avoid tangle of cables around bed-head
  • Double check that the handle and cord reaches smoothly to the patient's mouth
  • Position screen so it can be seen be scribe, team leader, and airway doctor

Technique

  • For DIRECT LARYNGOSCOPY the screen should not be used by the intubating registrar
  • Face the screen AWAY from the intubating registrar
  • Teach epiglottoscopy and tube delivery in the standard fashion (Richard Levitan principles)
  • Supervising consultant can fine-tune the registrar's technique by using the on-screen image
  • For INDIRECT LARYNGOSCOPY (ie VIDEO ASSISTED) a 4 step technique is advised
    • 1- look at the patient's mouth as the tip of the laryngoscope blade is gently inserted and advanced
    • 2- look at the screen as the position of the camera is optimised for a view of the glottis
    • 3- look at the patient's mouth as the tube or bougie is inserted
    • 4- look at the screen as the tube or bougie is advanced (delivered) between the vocal cords
    • NOTE that the TARGET (ie the vocal cords) should be towards the TOP of the screen rather than the centre, to allow a better view of the pharynx and the movement of the tube or bougie as it is delivered

Problems which may be encountered

  • Flat battery: this will result if the CMAC is not returned to the wall outlet for charging between patients
  • Auto Screen Off: the time-out is set to 10 minutes so ensure that the C-MAC is off until the last 3 minutes before intubating
  • Screen upside down: as the screen can rotate on its mount ensure that its orientation is correct
  • Screen lock: occasionally the software will crash and will not respond to power-off; if this occurs re-set the device by inserting a drawing up blunt needle into the reset button port next to the SD card slot
  • Tangle of cables: take care to check the position of all leads and cables prior to induction of anaesthesia

Debated role for this device

  • Opinion differs as to the way the C-MAC should be used in ED
  • Some consultants use it routinely, others reserve it for use if standard direct laryngoscopy fails
  • Intubating registrars must recognise that the D-blade requires a different technique for tube delivery and that it is advised to practice this on the Truman mannequin prior to a clinical encounter
c-mac.txt · Last modified: 2016/11/20 10:24 (external edit)