Jeepluv77 Posted July 13, 2009 Share Posted July 13, 2009 We learn how to identify difficult airways, but not really any ways to get around it. I'm going to set up a day to go in with a proctor and get some extra training and practice. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 14, 2009 Share Posted July 14, 2009 I'm not sure why you're timing your intubations, or who taught you that this was a good idea. Stress is absolutely the worst thing that you can add to a new skill and those that are telling you that you should be doing things faster simply want to seem good, instead of be good. Esse quam videri. Any new skill should be done slowly. Practice each part seperately until doing it doesn't distract you from the act you will do next. Check your equipment and supplies. Pick your blade, install it, check the light. Take it apart, put the parts away, and then start over. Do not move past this until you are no longer uncomfortable with it. Then check your tube. Attach the syringe, inflate the balloon, inspet for leaks, deflate baloon, lubricated, set in a comfortable position. See? When both of those come naturally, then put them together as a set. When the set is comfortable, practice your next skill, position the head. Once that is done, add it to your "daisy chain" of behaviors, never adding a new behavior until the previous links of the chain are rock solid. Before long you will do all of the mindless stuff mindlessly, even under pressure, leaving your mind free for the many parts of pt care that are not mindless. Get it? Right now it sounds as if you consider intubation "a" skill, when in fact it's a chain of many skills. Right now you are thinking of things that don't need to be thought about. You can practice much of that mental constipation away, but only if you break it into parts and practice the parts before attempting to unify it as a whole. Give it a try, I think you'll see a difference right away. Good luck. Dwayne Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 14, 2009 Share Posted July 14, 2009 I'm not sure why you're timing your intubations, or who taught you that this was a good idea. There's a tendency (especially around here) for medics to be off chest compressions or just letting sats drop for an extended amount of time while trying and trying to get their tube. As part of our school trying to emphasize not doing that, they gave us a 10 second goal for intubation (as well as keeping CPR going). Just part of the whole idea of not letting other areas of tx suffer just to get your tube. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 14, 2009 Share Posted July 14, 2009 There's a tendency (especially around here) for medics to be off chest compressions or just letting sats drop for an extended amount of time while trying and trying to get their tube. As part of our school trying to emphasize not doing that, they gave us a 10 second goal for intubation (as well as keeping CPR going). Just part of the whole idea of not letting other areas of tx suffer just to get your tube. Yeah, I can see that. It's just that that is a great goal if they also give you the tools to succeed at that goal. To apply that goal to newer students, to a skill they are uncomfortable with is simply bad teaching. Training animals is truly no different than training humans. You teach a skill, piece by piece, and once the skill is mastered you begin to "proof' it by adding stress. A new student can end up with an abortion of motions that may get some tubes in place in 10 seconds, but it will be a terribly rare student that will retain techniques for getting a majority of verified tubes using such a goal as motivation. Sorry man, it's just the behaviorist in me rearing it's ugly head. Doing intubations over and over as one skill will create habits, but rarely good ones. Practice doesn't make perfect, perfect practice makes perfect. Students need to slow down if they want to speed up. Thanks for your reply. Dwayne Link to comment Share on other sites More sharing options...
Jeepluv77 Posted July 14, 2009 Share Posted July 14, 2009 We have 30 seconds from the time pre-ventilation is stopped until ventilations are started again in which to drop our tube as per testing requirements. They have told us it usually doesn't work that way in the real world but that manikins are too easy to take longer than that. That if we can't drop the tube on a manikin in less time than that then we are going to be in trouble when it comes to a real patient. Needless to say, most students are in a competition to see who can do it the fastest. Link to comment Share on other sites More sharing options...
VentMedic Posted July 14, 2009 Share Posted July 14, 2009 Needless to say, most students are in a competition to see who can do it the fastest. Just remember "haste can make waste". I like to look at the cords and for abnormal potential problems which I can make not of for follow up. The cords on a manikin are in one position and they are not on a real person. Over anxious attempts can damage this structure to where it will affect the patient for the rest of their life. A good example was young 21 y/o college senior who partied a little too much. He actually probably just needed positioning to where he didn't inhale his vomit and a banana bag but he got intubated in the field to where he started vomiting from the repeated attempts (5). In haste to get the tube in "to prevent aspiration", they damaged his cords. He returned to college several months later with a trach and his cords were too damaged for speaking with any clarity. He also got a peg for feeding since his swallow was affected. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 15, 2009 Share Posted July 15, 2009 Just remember "haste can make waste". I like to look at the cords and for abnormal potential problems which I can make not of for follow up. The cords on a manikin are in one position and they are not on a real person. Over anxious attempts can damage this structure to where it will affect the patient for the rest of their life. A good example was young 21 y/o college senior who partied a little too much. He actually probably just needed positioning to where he didn't inhale his vomit and a banana bag but he got intubated in the field to where he started vomiting from the repeated attempts (5). In haste to get the tube in "to prevent aspiration", they damaged his cords. He returned to college several months later with a trach and his cords were too damaged for speaking with any clarity. He also got a peg for feeding since his swallow was affected. Ok, maybe I'm just really tired, but I'm betting that either Vent posted this while drunk, or she left her computer unlocked and someone posted in her name? Any takers? Dwayne Link to comment Share on other sites More sharing options...
AnthonyM83 Posted July 15, 2009 Share Posted July 15, 2009 Why? Seems good to me. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted July 15, 2009 Share Posted July 15, 2009 Why? Seems good to me. Other than being undoubtedly one of the most intelligent medical people on the City, she's always seemed to be committed to posting with an efficient, intelligent use of structure, spelling and grammar. I find many of each type of mistake above... I'm still pretty comfortable with my impostor theory... Dwayne Link to comment Share on other sites More sharing options...
VentMedic Posted July 15, 2009 Share Posted July 15, 2009 Apologies. These cross country flights are getting tiresome. Just remember "haste can make waste". I like to look at the cords for abnormal anatomical structures that can create potential problems which I can make note of to follow up later with the Intensivist. The cords on a manikin are in one position and really do not give the best representation of a real person. When doing cllinicals, one should examine with their preceptor the movement of the cords if the person is not on a paralytic. Even while on a paralytic, the positioning and structure of the cords and surrounding tissue can be examined more closely if time permits. Over anxious attempts can damage the cords to where it will affect the patient for the rest of his/her life. A good example was young 21 y/o college senior who partied a little too much. He actually probably just needed positioning to where he didn't inhale his vomit and a banana bag but he got intubated in the field to where he started vomiting from the repeated attempts (5). In haste to get the tube in "to prevent aspiration", they damaged his cords. He returned to college several months later with a trach and his cords were too damaged for speaking with any clarity. He also got a peg for feeding since his swallow was affected. I also had a patient with a provider who thought he was shoving a CombiTube down the throat of a manikin and that ended with a trach/peg set. Granted, the patient's actions by getting drunk or drugged may have led to the intubation but it is also the provider's responsibility to do no more harm and to realize when another alternative should be used. When I am precepting students, at least in a controlled environment, I may have them first just do an examination with the laryngoscope without worrying about placing the tube. It is unfortunate that some can not recognize the basic anatomy within the oral cavity and pharynx. Some instuctors over simplify intubation and students get caught up in playing with the "skill" such as seeing how many tubes they can sink on the manikin. Link to comment Share on other sites More sharing options...
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