1st intubation! Any advice?

[knhollenbeck]

8) ok to the response to the person above me about all the education crap he wrote, listen when it comes down to it, put the dang tube in, you are paid to do a job, all the education in the world will not prepare you for the streets, things are a whole lot different, all the book smart people and thier views and opinions are nothing but a bull of crap. The greatest medics and basics come from road experiance, I let all my basics do everything as long as they are doing things right, you only learn by doing

[mobey]

8) ok to the response to the person above me about all the education crap he wrote, listen when it comes down to it, put the dang tube in, you are paid to do a job, all the education in the world will not prepare you for the streets, things are a whole lot different, all the book smart people and thier views and opinions are nothing but a bull of crap. The greatest medics and basics come from road experiance, I let all my basics do everything as long as they are doing things right, you only learn by doing

Oh me goodness...... Tell me it's April!!!

Is this a joke????

I can't watch! :shock:

*turns his back to the gang style beating that is about to start*

[knhollenbeck]

ok to the person above me yes education is important, but in the real world, when you go to calls, you have 15 people standing around you, moms screaming to save thier kid, a wife begging you to save her husband, people getting in your face because you took to long to get thier in thier opinion, text books and teachers cant teach you that stuff. Everything becomes first nature, you react to everything and you do it right, and yes if you were trained right by a good partner

[Anglosaxonboy]

Ruffems hits the nail on the head. If the patient needs tubed, then the time it takes to bang it in before loading is negigible. At the back of the wagon would be great in an ideal world, but that isn't always possible. I "served my apprenticeship" in Cape Town, S.A. and the "sandpit," we carried out procedures in some strange places, similar to what ERDoc describes! However, as my Para drummed into me, its not our comfort that is important, its the patients. So he taught me to tube with the patient lateral...I hear gasps, but its not difficult and as we all should be aware, lateral is our friend. How many times have you turned up to a multi-wagon call and you can hear a gargling noise as you are being filled in by the scene coordinator...upon closer inspection, there is some poor soul strapped down to a board, supine and drowning in his own juices! Why can't he be lateral? Grab the edge of the board and make it so, he's happy because now he can breathe! Simple airway management. But you can't transport with a board lateral....heck, yes you can! Try practicing it on your partner when you have some time, and get the dummy out. Start tubing it lateral, you'll be surprised. Forget whether we are "comfortable", its the paying customer who's turning blue and thinking he's not getting good value for money at this precise moment that counts.

Regards all, keep the faith!

[Mateo_1387]

...the person above me about all the education crap he wrote...

Above you.......you said it, not me !

...all the education in the world will not prepare you for the streets, things are a whole lot different, all the book smart people and their views and opinions are nothing but a bull of crap.

I agree that the streets and the classroom are two different environments. Without an education, you are set up for failure.

The greatest medics and basics come from road experience, I let all my basics do everything as long as they are doing things right, you only learn by doing

Some of the best medics I know have college degrees ! :shock:

Where can I get my own basics?

Obviously, there are ways of learning besides monkey see monkey do. Your basics need to go to paramedic school, not picking tidbits up from you.

ok to the person above me yes education is important...

Change you mind already?

...but in the real world, when you go to calls, you have 15 people standing around you, moms screaming to save their kid, a wife begging you to save her husband, people getting in your face because you took to long to get their in their opinion, text books and teachers cant teach you that stuff.

So you think someone without even going through a basic class can handle this situation? According to you if you just pick it up from your partner, you will be the best. So do not worry about going to school, learning the medicine and science behind what you do, just go from joe off the street to paramedic in the ditch. :?

I would think that the more you prepare before the situation, the better you can react to the situation. Why go into situations blind? Sure you get better with experience, but without that foundation, you are set up to fail.

Textbooks cannot teach you to be experienced. But it will take you a long time to be "experienced" if all you do is go at it blindly and try to "wing it" :wink: Be educated, see the light !

Everything becomes first nature, you react to everything and you do it right, and yes if you were trained right by a good partner

Good partners do not make a good medic. It is weak to rely on your partner to be "trained."

Now for my own rant...

Your reply to the original poster was weak. You did not add any useful information to this discussion. Your two replies on this thread held nothing of sustenance. The Original Poster has consistently taken the time to ask very good questions. He has not posted "crap" that I have seen, and has thus far contributed to this site to make it better. He asked for our thoughts from the city, and I gave mine. I tried to show him respect to show him where my thinking leads me and possibly give him information he previously did not have, or may have just wanted re-enforced by members of the city. You wrote

...just put the dang tube in...

Puhhleeezzee......I think everyone here got that part. What we were discussing was when the tube should be put in. Why not take some time, reply to this post about when, where, and why the tube placement is important with the trauma patient. When do you think it is important to place the tube? Does it make a difference if the patient has a pulse or not? Contribute to this forum with something we can all use.

[knhollenbeck]

ok, i see everyone is getting bent out of shape on my comments, first, i never said education was worthless, you need the education, second, if you have a good expericenced partner it makes all the difference in the world, third arent the basics we were taught not ABC's, airway is the most important thing you can do for a patient, you can do all the cool things like, hook up the 12lead, defib pads, start iv's, but the most single impprtant thing you can do is get an airway established, whether it be a basic airway, combi-tue, or ET tube, you got to have a good airway or the patient dies. Should you tube on the scene? it depends on your patient, do you stay and play, or get to the hospital. Dont move that patient untill you have established an airway, opening up a patients mouth and putting in an oral airway takes 5-10 secs, or suctioning out thier mouth. My training and experiance is that you should practice tubing at different angles, turn up loud music, have a bunch of people around you watch you. Ok and the answer the question about my basics do everything, i let them do things in thier scope of practice, alot of medics think that the basics are thier to drive them to calls and thats it, i try to have my basics get involved in everything, thats how they learn things, my partner now, is a basic and he is the best partner anyone could have, I have learned that I would rather have a damn good basic partner then a half ass medic partner.

[chbare]

"but in the real world, when you go to calls, you have 15 people standing around you, moms screaming to save thier kid, a wife begging you to save her husband, people getting in your face because you took to long to get thier in thier opinion,"

A bit overdone on the drama eh? Most of my real world EMS calls were how to deal with BS at 3 am. A properly educated paramedic will have an extensive amount of clinical experience where they should be placed in a leadership role.

Take care,

chbare.

[knhollenbeck]

no not overdone on the drama, everyone gets those wild calls, i have almost been assulted two times in the last month, so no not overdone, The point i am getting to is that no matter what is going on or around you when you are getting ready to tube someone you have to get into a different frame of mind, you have to get into a zone because it takes alot of focus to tube someone, so you might as well practice in different situations so WHEN you are in that situation your like hey i practiced it and i can do it, and yes i deal with alot of the 3am bs calls too, it is all about confidence!!! I think they should have national compitition on tubing people that would be a blast !!!! In order for anyone in our company to be a Sr medic you have to do a whole bunch of stuff, thier is a big check list you have to get checked of on.

[mediccjh]

Hello...

A few nights ago during my internship I succussfully performed my first field intubation. It was a trauma arrest and a fairly messy scene. Multiple GSW victim in PEA with police performing CPR on arrival and alot of blood on the ground.

My preceptor had told me that during our first code my only job would be airway. Due to this I had everything setup before everyone else was done packaging the patient. My preceptor said go ahead and after some initial issues with my view (I did not set myself up well just sitting there on the ground behind the supine patient) I got it.

Normally you BLS a trauma victim to the ambulance unless you need to treat flail chest or tension pneumo or your BLS airway isn't good enough, correct? Someone on scene suggested next time that I intubate "at the back of the bus" or in othe words bringing the patient to the back like we are going to load them but stand there and intubate right before going in.

What do you guys think about doing it at this time? It seems to make sense to me with the only draw back being a slight delay to transport time. It provides a good angle (just like an OR intubation in a sense) and if it doesn't work you can just hop in and go.

What I don't like is it makes everyone else stop what they are doing to wait for you and delays transport time.

Thanks for your thoughts!

Sounds like you did a good job.

When you're on the scene of a trauma, the patient needs a surgeon. Scoop and run, do everything, including advanced airway, on the way to the hospital.

[Texman]

Part of this has already been said but its simple. What makes you comfortable? For me it IS in the back of the box. Controlled environment! I can limit who is next to me. When you have the family next to you screaming You HAVE to save them it makes for added stress none of us needs. The only disadvantage I have found in the box is the angle is sometimes odd. Every situation is different though. I have intubated in the middle of McDonalds before with many people watching. Whatever the situation you have to be comfortable with your own abilities. Hope this helps.