Etomindate

[CTXMEDIC]

you missed the point. the doctor, after making a big to-do about how great the new gear was, FAILED to get the tube. as for my skills, im very secure in my abilities. BTW, i have NEVER missed a tube, yes, even in training in the OR's...im sure my time will come but so far ive been lucky. i also know better than to make a new piece of gear sound like the best thing ever and then fail to perform in front of a live audience.

[CBEMT]

Patient: "Well i feel my throat closing up and i can barely breathe"

Medic: "Sir, barely breathing means you can still breathe"

Patient: "Cant you put a tube in me to help me breathe"

Medic: "No, sir. Tell me when your throat is completley closed and you stop breathing, THEN i can try to put this tube down your closed airway" "Oh, and dont fight me sir or ill have to sedate you"

Patient: :shock:

Yup, that's pretty much us. We can ask for enough Versed to knock our their respiration, but then what?

[akroeze]

Same here too

[Doczilla]

i think the whole 'dont let medics intubate' argument is a buncha crapola, ive seen FAR more docs and med students miss a tube than i have medics. i saw a guy a few weeks ago going on and on about this video laryngascope they got. glidescope i think it is. he let a first year try to get the tube and the kid couldnt get it. of course im in the corner goin :roll:

so this doc is like trying to tell everyone how great this multi-thousand dollar gadget is, and on and on he goes. well after the student tried twice and FAILED, the good doc takes over and FAILS as well. he ended up using a good old MAC blade....we just snickered and walked out...

Those that assume the Glidescope is just an easier way to intubate using normal methods usually figure out that isn't the case by about intubation #2. The tool is a great one, but has its own technique and particular procedures that seem similar but are different than those used during direct visual laryngoscopy. Placement of the blade, fine movements of the hands, threading of the tube, simultaneous withdrawal of the stylet with advancing of the tube to name a few. It, like anything else, is a skill that needs a lot of practice. There are also those airways better managed by direct laryngoscopy, just as there are those better managed with a Glidescope, or fiberoptic bronchoscope, or digital intubation, or whatever.

Be careful how harshly you judge those who are just learning a skill. Considering that you're not even sure what the device was, I'd say that your airway experience is limited, and you should probably adjust your attitude when criticizing the technique of others.

Doctors aren't always the ones that are expected to intubate.

Please clarify.

'zilla

[VentMedic]

Please clarify.

'zilla

There are many hospitals were doctors are not always the primary intubator. NPs, PAs, RRTs and RNs can also intubate in a hospital and on transport. And, a doctor specializing in onocology or urology may not tube again after residency.

[akroeze]

Out of curiosity is intubation a skill that all physicians, regardless of specialty, should be competent in? In other words, should it be one of those things that are minimum standard? Sort of like BP, lung auscultation, that kind of thing you should expect that any doctor regardless of their specialty would be able to do.

[Arizonaffcep]

There are many hospitals were doctors are not always the primary intubator. NPs, PAs, RRTs and RNs can also intubate in a hospital and on transport. And, a doctor specializing in onocology or urology may not tube again after residency.

Sure they will...just a little further south...

[Arizonaffcep]

Those that assume the Glidescope is just an easier way to intubate using normal methods usually figure out that isn't the case by about intubation #2. The tool is a great one, but has its own technique and particular procedures that seem similar but are different than those used during direct visual laryngoscopy. Placement of the blade, fine movements of the hands, threading of the tube, simultaneous withdrawal of the stylet with advancing of the tube to name a few. It, like anything else, is a skill that needs a lot of practice. There are also those airways better managed by direct laryngoscopy, just as there are those better managed with a Glidescope, or fiberoptic bronchoscope, or digital intubation, or whatever.

.'zilla

It has always been my understanding that the Glidescope is a RESCUE tool, where DL should be used primarily. If you can't get it with DL, move to a different tool. Of course, not all the residents at the hospital I work at follow this thought process. Hope they don't go to a hospital that doesn't have any of the fancy stuff... :?

[VentMedic]

Out of curiosity is intubation a skill that all physicians, regardless of specialty, should be competent in? In other words, should it be one of those things that are minimum standard? Sort of like BP, lung auscultation, that kind of thing you should expect that any doctor regardless of their specialty would be able to do.

If you work where you are not going to utilize a skill, why take time from other "skills" that your specialty may require more? I would much rather have a cardiac surgeon continue to perfect his/her surgical skills since there will be many others around that can do the intubation in the OR. Intubation or any skill is something that should be done by people that can remain proficient in it. A physician's other skills and knowledge may be put to better use if one of the many other healthcare professionals can do the intubation leaving the physician to oversee or start another advanced procedure or operation.

As for my statement earlier, intubation is a skill that Paramedics should be expected to be proficient in and yet that is not always the case for every paramedic in every service.

[CTXMEDIC]

It has always been my understanding that the Glidescope is a RESCUE tool, where DL should be used primarily. If you can't get it with DL, move to a different tool. Of course, not all the residents at the hospital I work at follow this thought process. Hope they don't go to a hospital that doesn't have any of the fancy stuff... :?

That was my understanding as well. I first saw it in use about a year or more ago. the glidescope reps were in the ER and they (the docs) were finding every excuse under the sun to intubate people. theyd bring this thing bedside like it was the holy grail or the original napkin used at the last supper. the crowd would Ooohhh and AAAhhhh. The doc using it had used it in some airway course and got the tube first time. They also pulled out the lighted bougies, it was like an intubation expo.

Ive also seen people use the bougie (never used it myself) and directly insert it while visualizing the cords. Im like, well if you can see the friggin cords, why not just pass a tube instead of this stupid thing? I thought the bougi was to be used blind... :?