While using a Miller blade, you lift the epiglottis and the arytenoid cartilage becomes visible. What should you do next?

• A. Ventilate with a bag-mask device
• B. Place endotracheal tube in the trachea
• C. Remove the blade
• D. Reinsert the blade

Answer: (B)

With a Miller blade, lifting the epiglottis exposes the glottic opening; seeing the arytenoid cartilage means you have a direct view of the vocal cords. When the cords are visible, the appropriate next step is to advance an endotracheal tube into the trachea under that direct vision, usually over a stylet to guide the tube. After insertion, confirm placement with end-tidal capnography and bilateral breath sounds, then secure the tube. Ventilating with a bag-mask would be slower and less definitive once you have a clear view of the cords, and removing or reinserting the blade isn’t necessary once the tube is being advanced.