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First O.R. rotation

Lone Star


Welcome back Dear Readers!

If you've been following my travails through medic school, y'all know that I've recently begun my clinical rotations as a Paramedic student.

Yesterday was my first rotation in the Operating Room. I was there to get experience in intubation. I've never been treated like a complete idiot before, and I'm not liking the feeling!

The arrogance of some of the anesthesiologists and doctors was overwhelming, and I don't know how I overcame the urge to just slap the snot out of some of them!!

I relize that they don't know me from Adam, and Emergency Medicine is a 'dog eat dog world', (hell, I've been part of the ass-chewing frenzy on more than one occasion).....but to be dismissed summarilly simply because I'm a student was something I didn't see coming down the tracks!

I had 10 opportunities to try to intubate patients that were being operated on, but only got 2 actual attempts. So far, I haven't had one successful intubation.

The first was denied simply because I couldn't get the mouth open far enough to fully insert the laryngoscope blade enough to even think about sweeping the tongue to the left (I kept bumping the end of the laryngoscope aginst the patient's chest) and the second was because I had what sounded like 14 people trying to tell me 47 different things all at the same time. I finally backed out of it because I was fearing that I was approaching the dreaded 30 second mark, and just bailed out of it because panic was setting in....hard...

Of the other opportunities, the surgeries started early, so by the time I got to the theatre, the patient was either intubated, or there was a change in plans and they only used an LMA and the Nurse anesthetists had already done it.

Add to that being told that "Doctor X doesn't allow students in his Operating Theatre"...

I got to observe a few Nurse anesthetists dropping tubes like it was nothing more significant than poking a straw into a juice box. I even got to see the human version of what I saw while tubing the mannequins. Yeah, it was cool as hell, but it was also frustrating as hell because I was there to do it, and somehow, fate denied me the opportunity.

My philosophy has always been "Learn one, do one, teach one"; unfortunately, this doesn't seem to be shared throughout the medical community.

We've already had one student drop 7 endotracheal tubes on his first O.R. rotation (a feat I won't be able to beat),

I don't know where I'm going wrong here! I've been told that I'm being 'too gentle' (isn't that part of what we do? You know, try not to aggrivate possible injuries/do no harm)?

We're taught that to place the patient in the 'sniffing position' we use the head-tilt/chin-lift method. This is to protect the cervical spine and to open the airway. In the O/R, I watched the nurse anesthetists grab the patient on both sides of the head (about ear level) and move the head that way ...... thats NOT how we're taught to do things! Another BIG difference is that with a mannequin, the tongue isn't nearly as huge and floppy as it is in a paralyzed patient!

I only need to accomplish 5 intubations, but at the rate I'm going, I'll be pulling extra shifts in order to reach this miniscule goal!

I understand that there's a hesitancy when approaching a new task, but is it REALLY necessary to have an anesthetist scream at me while reminding me that succinylcholine and propofol wear off? I know they're not a 'permanent drug', otherwise there would be millions of people on life support because they'e had to unergo some form of surgery (myself included).

Maybe I'm trying too hard, maybe I'm making this more complicated than it really is....I just want to succeed and be the best damn medic I can possibly be! All I can see at this point is that I've failed miserably, and THAT is unacceptable in my book!

I'm not stupid by any means, but yesterday's venture into the Operating Rooms of the local hospital definately has me questioning my abilities and if I'm even qualified to be in medic school......


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Hey Lone, been there done that.

Remember, I'll bet that at least one of those doctors who won't let students in has had a very bad experience with students.

Hell one of my co-students went so far as to break the top front two teeth off in an aggressive intubation. The Anesthetist is probably still paying that lawsuit off.

They have every right to be leery of someone that they do not know. But you stood there and listened to them, got some really good visual experience and I'll bet the next time that you see the docs or NA's you will be welcomed a little better. That was the way it was for me.

I even pulled a couple of extra shifts with these same Nurse anesthetists and docs to get some extra experience. Once they felt comfortable with me they let me attempt intubating a malampati 4 with a huge bull neck. I got the tube, difficult tube but it showed them that I had learned a great deal from them.

Keep your chin up, think of it this way, you now know what some baby medic students feel like when they first start out, you will never make those students when you are precepting them in the field feel like you felt in the OR the other day, am I right?

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Having dealt with the arrogant Para-gods, I've already deccided that IF and when I get to be a preceptor, I'm going to handle it completely differently. I know how it feels to be a student that gets shoved off to the side, or made to feel like they don't belong. I've already made up my mind that's NOT how I want to do things.

I can understand taking the reins if the student is completely 'clueless' and is in danger of harming the patient instead of helping them. But if it's just a matter of denying the student the opportunity based on the fact that they don't have as much experience as I do...thats just wrong!

The student is in my truck to LEARN, not be treated like a 'wall flower' and only observe. I'd make sure they get their hands dirty, and do more than just schlep gear.....

I'd want my student to be included in all the calls that I feel they can handle, and even push them outside of their 'comfort zone' because we both know that hardly anything in EMS lives within the 'comfort zone'!

Like I stated earlier, I understand that the Anesthetist and the NA don't know me from Joe Blow my education level and how well I'm doing. I further understand that there IS the patient to consider. But to summarilly dismiss the student simply because they're a student is wrong. After all, even THEY were 'students' at one time!

I did meet one really cool NA who actually took the time from babysitting a second year NA student to talk to me about not only intubating, but we also discussed cadio as well. Hell, she even wanted to know when I was coming back to the O/R so that she could see f our sechedules meshed. Now THAT is how it should be done!

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