Intubations for 2009

[Kiwiology]

*Kiwi meekly chips in his intubations for the year .....

1, and it was a success!

Edited December 7, 2009 by kiwimedic

[HERBIE1]

*Kiwi meekly chips in his intubations for the year .....

1, and it was a success!

Like I alluded to, my concern over the years has gradually shifted from how many procedures I could get(like a brand new medical student) to how could I obtain the best outcomes for the patient. Sometimes it has nothing to do with medical skills, but in convincing a patient to be compliant with their medications and/or treatment, or maybe getting them to change bad behavior. Sometimes it's training the next generation of providers to do the right thing, and to take pride in their work.

Often it's the little thing that make all the difference. Your patients don't care how many ETI's you had for the year as long as you do the best you can and do what's in their best interests.

[VentMedic]

Like I alluded to, my concern over the years has gradually shifted from how many procedures I could get(like a brand new medical student) to how could I obtain the best outcomes for the patient. Sometimes it has nothing to do with medical skills, but in convincing a patient to be compliant with their medications and/or treatment, or maybe getting them to change bad behavior. Sometimes it's training the next generation of providers to do the right thing, and to take pride in their work.

EMS still has not reached out for preventitive medicine although some aspects of prevention are emphasized if you are involved in Public Safety.

Often it's the little thing that make all the difference. Your patients don't care how many ETI's you had for the year as long as you do the best you can and do what's in their best interests.

When I had surgery a few years ago, I did ask about the qualifications of the anesthesiologist. Even though I have nothing against CRNAs, it was my preference not to have one doing the procedure.

My vocal cords deserve someone who can intubate and if that is part of your job description, you should be skilled and well educated about doing it just as you should know when not to do it. If a surgeon has one's best interests, he/she should be good at surgery. Just best interest of the patient is not always enough in an emergent situation if one can not perform the task at hand. A patient may not always plan ahead with a list of questions to ask you at scene but they disserve to have someone who is proficient in a few skills and have the knowledge to use them to the best interests of the patient.

If you can not get the time in on actual patients either in or out of the hospital, your company should provide at the very least an intubation dummy head for practice. With that you can also practice organization and communication with your partner so there is no fumbling of equipment when the time finally comes.

Edited December 7, 2009 by VentMedic

[HERBIE1]

EMS still has not reached out for preventitive medicine although some aspects of prevention are emphasized if you are involved in Public Safety.

When I had surgery a few years ago, I did ask about the qualifications of the anesthesiologist. Even though I have nothing against CRNAs, it was my preference not to have one doing the procedure.

My vocal cords deserve someone who can intubate and if that is part of your job description, you should be skilled and well educated about doing it just as you should know when not to do it. If a surgeon has one's best interests, he/she should be good at surgery. Just best interest of the patient is not always enough in an emergent situation if one can not perform the task at hand. A patient may not always plan ahead with a list of questions to ask you at scene but they disserve to have someone who is proficient in a few skills and have the knowledge to use them to the best interests of the patient.

If you can not get the time in on actual patients either in or out of the hospital, your company should provide at the very least an intubation dummy head for practice. With that you can also practice organization and communication with your partner so there is no fumbling of equipment when the time finally comes.

LMAO

All I can say is..wow.

[island emt]

3 for 3 attempts at ETI this year. All first attempt. I was taught many years ago by a top shelf gas passer to take a quick look with the scope and decide how your going to proceed with the type of airway needed.

There were several others that we managed with aggressive oral /nasal airways and BVM's also CPAP is a tube saver for many respiratory distress patients.

We don't get many opportunities ,but we do spend time every month with the head and twice a year with stan the sim man.

[spenac]

My question to those that have less than 100% success is did you catch and correct the miss or did the hospital? The only true fail is missing a missed tube. So far I am 100% first attempt this year.

[Novisen]

About 30 intubations, just 4 in ambulance. And about 100 LMA:s. I have spend most of my time in the OR this year.

Edited December 8, 2009 by Novisen

[DwayneEMTP]

3 for 3 attempts at ETI this year. All first attempt. I was taught many years ago by a top shelf gas passer to take a quick look with the scope and decide how your going to proceed with the type of airway needed.

The blade passing the teeth is considered an attempt here...no peeking.

I tend to think that this is a good rule. I think it causes you to use more intelligent, non invasive anatomical indicators to help guide your intubation decisions as opposed to a quick, "Oh, I see the cords! Let's do this guy!'

Plus, it's my guess that most 'quick looks' might as well have been attempts when all is said an done as they end up not being quite as quick as they should have been.

Not dissin' your service or your advice brother, just offering a possibly different perspective.

Dwayne

[HERBIE1]

My question to those that have less than 100% success is did you catch and correct the miss or did the hospital? The only true fail is missing a missed tube. So far I am 100% first attempt this year.

In my case, I define a miss as when I was unable to visualize the cords adequately and aborted the attempt. In other words, I wanted to intubate, but was unable to do it. (Again, my partner was able to do it)

[island emt]

The blade passing the teeth is considered an attempt here...no peeking.

I tend to think that this is a good rule. I think it causes you to use more intelligent, non invasive anatomical indicators to help guide your intubation decisions as opposed to a quick, "Oh, I see the cords! Let's do this guy!'

Plus, it's my guess that most 'quick looks' might as well have been attempts when all is said an done as they end up not being quite as quick as they should have been.

Not dissin' your service or your advice brother, just offering a possibly different perspective.

Dwayne

No foul dwayne: I should have clarified a little better. In a facial trauma or bloody airway I take a quick look see to make the determination of type of classification with the malapatti scale

When I say quick It means in & out in ten seconds or less. Do I need to go with suction at the same time as the tube to clear the airway from secretions? or are there anatomical issues that will make it a harder tube or need an alternative method of securing the airway. You ever had a pt that outwardly looked to be a 7.5 and when you got in the guy has a trachea the size of the holland tunnel ?