1st intubation! Any advice?

[letmesleep]

The problem with this question is that there is NO real answer. Does it come down to your comfort or the Pt's needs? Both! Where you decide to slam the tube is going to depend on the situation of every call. If you have the drama, you may need to move, if you are secure, you may have the time, BUT this Pt needs to get more definitive care than can be given in the street, and WE (all of us) know this.

Were you (the OP) wrong in your decision? I'll have to say no based on your post, but keep in mind to that your doing a clinical so take the advice of your preceptor in to consideration as well. If they had had an issue with your decision they should have pushed you to change it, but since they didn't, you made the right one. Sounds like it was stressful enough, and you got the tube any ways, GOOD JOB!

As far as the education vs. experience argument. Are you kidding me with this? EDUCATE, TRAIN, EDUCATE, EDUCATE, TRAIN, EDUCATE! What is the question?

[firedoc5]

As far as the education vs. experience argument. Are you kidding me with this? EDUCATE, TRAIN, EDUCATE, EDUCATE, TRAIN, EDUCATE! What is the question?

Outstanding way to put it. You can never educate, train, or practice too much.

Congrats. Now that you've got your first field tube out of the way, just remember no two tubes are a like. Some easy, some hard, and some you've got to be kidding me!' I remember my first tube. I just looked, inserted and it slid right in, and it was over. I was like, 'OK, now what'?

In the future when intubating, just remember to not get in a hurry. When practicing, develop your own routine and technique. Just remember the basics such as, don't pry back against the teeth, observe the tube until the cuff is past the vocal chords, and check placement immediately. At least that's how I first learned.

[jsadin]

Firedoc is right on the money about no two tubes being alike. My first tube in the OR was cake...textbook presentation, slid right in, anesthesiologist was impressed, etc. The next one I looked like the monkey with the proverbial football. Remember the basics, remember your anatomy and don't be afraid to pull out the laryngoscope and oxygenate for a bit while you gather your shat together.

[freethinker]

If I were that partner, I'd say 'You expect me to babysit you? That puts me, the squad, and worst of all, our patients at risk. Healthcare is not for cowboys.' I think what matters most is attitude. I've seen some really smart people who still think EMS is cowboy medicine.

[jsadin]

There's a difference between educated and smart. I've seen some well educated folks that I wouldn't let walk my dog.

[jwraider]

Thanks for all the helpful replies!! I appreciate your thoughts and advice.

[RomeViking09]

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

I good education comes from both the classroom and the streets, while yes you can learn somethings in the street you do your patients a dis-service by allowing an untrained EMT-B (or even an EMT-I) perform a skill not covered in their classroom education. That sad I learned IVs in the field as an EMT-B before finishing EMT-I and I started to learn ECGs and Pharmacology from Medics I worked with while a Basic and EMT-I. But there is a limit, don't let your EMT-B do the medic's job so they can "learn" it is one thing to show someone how to read ECGs or what the drugs are and not have them making the call it is another to let them start lines and drop tubes before they have the book learning needed to understand what is going on with those skills. I run across FF who are not EMTs starting IVs and 70% of the time have to restart the line b/c they don't check it (oh I got flashback I am in the vine... forget that I went through the vine and the line is no good) your clinicals and field internships are when you need to start skills on the street not b/c you medic is trying to "teach" you or b/c your lazy. And don't forget the legal issues with exceeding your scope of practice. The best EMTs and Medics I know are always in the books and learning from the street, most of the bad medics I know have the attitude that once you finish school you can put the books down you just need to do the required co-edu and nothing else.

[brentoli]

Where, in the world, did this influx of anti-education people come from!?!?!?

[HERBIE1]

Congrats on your first tube! If you are in a low volume area or somewhere where you don't get the acuity you need, opportunities for intubations may be few and far between. It's like any skill- practice makes perfect. Just like anything in EMS- no 2 cases are the same. Funky anatomy, emesis, blood, teeth, short/fat necks, swelling, spasms, wrong sized tube, foreign bodies- you never know what to expect, so expect the worst and be happy if it's not complicated. If you are lucky enough to have RSI protocol- we don't-it sure makes things easier. You also need to forget the ego thing and know your limitations- even ER docs need to call an anesthesiologist sometimes, but we don't have that luxury. A doc would also much rather hear you opted to simply give good ventilations with an amb bag and an oral airway vs screwing around with a tough tube. Of all the true saves(survived to discharge with few or no deficts) from full arrests I can recall, many were achieved without ever intubating the patient.

As long as this person is being adequately ventilated and the airway is protected, the manner which you achieve the results is irrelevant. Many times, I've had a bad trauma, or a complicated medical arrest, you are so busy doing other things- radio report, medications, analysis of a rythm, decompression- that the intubation waits, as long as the person is being properly oxygenated. Obviously, the amount of help you have is also key here.

As for trauma, like was mentioned above- throw and go- and do whatever you can enroute to the trauma center, the clock is ticking. These patients need a surgeon if they are to have any chance at survival.

As you will see, there is no set "right way". Each situation is different- scene safety, lighting, puddles of water, mud, cockroaches and rats running around- obviously the back of the rig is the preferred location. Experience- and until you have that- a seasoned partner- will tell you what's your best option.

Again- congrats- you never forget your "first time". LOL

[akroeze]

Kind of a side topic but are terminations of resuscitation not that common for traumatic arrests?

I mean in general we pronounce medical arrests on scene... is trauma less common?