Intubation woes

[runswithneedles]

I had my first OR clinical. And had no attempts at it because all of the patients are either already intubated or getting an LMA or simply not a suitable candidate for a Paramedic student (loose teeth, very anterior airway, small mouth big tongue,etc) But while I was in their I got this panicky feeling of Oh ***t this is it. And just got incredibly nervous for the process. I didnt pass out or anything and I certainly didnt shake or throw up as other nursing students had. But I realized that this is something I must have resolved before I step into that OR again. I stood back and took a breath for 5 seconds and it helped a little. But their must be something more I can do. I practiced on the dummy till I could repeat the method in my sleep. Any recommendations.

[croaker260]

OR time, just like airway management in "the real world" is notj ust about the skill, or the tube, but about a global appreciation of the patients airway and respiratory needs.

May I suggest some "recreational" reading to give you both a better understanding and better preparation?

http://www.amazon.com/Manual-Emergency-Airway-Management-Walls/dp/0781784948/ref=sr_1_1?ie=UTF8&qid=1329370132&sr=8-1

Its really considered a "go-to" text.

[runswithneedles]

Thank you very much. Ill go ahead and look into buying that.

[DwayneEMTP]

You know what helped me?

Remembering that I chose a career where people call me for help. That I've chosen to be the highest level of care on a call, and that getting nervous retards my ability to provide the best care that I can. That I've given up my right to feel that way.

It sounds silly of course, but I believe that it's true. You worry about how you'll look, what the OR staff will think, whether or not you'll succeed..and that is all very indulgent, selfish thinking. You have no right to think like that any more, right?

The ER staff is going to respect you if you go into your clinical with non arrogant confidence, with a belief that you will do all in your power to succeed and if you find that you are unable, that you will lateral to someone else at the appropriate time. And then ask them to explain where you went off into the ditch. Just like a real, live, paramedic.

You MUST stop worrying about what other people think, and you MUST stop considering failure or you will second guess every decision to the point of being impotent.

Now's the time to decide if you really want to be a paramedic. And if you do, take a deep breath, focus on your tasks, remove all of the nonsense, and go in and get your tubes. People that shouldn't have the right to carry your bags have been doing it for ages now...you can do it too.

Ok? See? Simple... :-)

[BAYAMedic]

Well said Dwayne and I know I may get flamed for over simplifying it but think of it this way. Do you have the same kind of anxiety when you start an IV? Because that is putting a small plastic tube in a larger meat tube, all while not having visualization. Intubation is the same thing, all while having the direct view of where the tip of the tube is going. Everyone has two tubes to choose from, and the majority of patients dont desaturate in the time frame of Jeopardy theame music, so take your time. Take a deep breath, know you practiced your butt off, and go for it!

[Kaisu]

The first intubation attempts I made in the OR were comical (now). My hands shook, flop sweat ran down my face and body and a dropped instrument made me startle out of my mask. I kept at it. It was tough. It was difficult to stick with it but I made it. Had 18 tubes in the 48 hour OR rotation and double that many LMAs. The time to get over your nerves is now, in school because it doesnt get any easier in the field.

Good luck

edited because I said ED, meant to say OR.

Edited February 16, 2012 by CrapMagnet

[Vorenus]

Just make yourself usefull, ask what you can do. Hang around the docs and ask alot of questions.

Don`t worry about not having done an ETT yet, in my first days I was mostly in the oral and maxillofacial surgery OR, you can imagine there aren`t alot of intubations suitable for a student, but in that time I had time to get deeper into the basics and all the things that are important and happen throughout ETT.

Just don`t stay quietly in the corner, you won`t benefit from that.

[runswithneedles]

Thanks Dwayne. I'll start using that technique. And I dont have problems with IV's. I generally get them and when I dont I ask what I couldve done better if anything. I need to do my rotations at your location crapmagnet. It was ridiculously slow at the this OR rotation. What makes it worse is we only have a handful of rotations in our semester for the paramedic students.

[BAYAMedic]

I would encourage you to re-read my post RWN, The point I was making had nothing to do with your success or failures with IVs. It has to do with the simplification of Airway management, and not psyching yourself out. I have no idea how long you were a Basic before you started medic school, but I was for 7 Years, Not all of that time working with an ALS Provider. I had the skill of intubation so glorified in my own head, that when the medic popped his laryngoscope open, the clouds parted, the heavens opened up and the angels sang. Another life saved. I had created some XXL sized clown shoes to fill. Then came my OR rotation, (after like you having passed hundreds of mannequin tubes) and I realized that its a far more simple procedure than I had made it out to be. Take it slow, and make it smooth.

Fireman1037

[croaker260]

I would encourage you to re-read my post RWN, The point I was making had nothing to do with your success or failures with IVs. It has to do with the simplification of Airway management, and not psyching yourself out. I have no idea how long you were a Basic before you started medic school, but I was for 7 Years, Not all of that time working with an ALS Provider. I had the skill of intubation so glorified in my own head, that when the medic popped his laryngoscope open, the clouds parted, the heavens opened up and the angels sang. Another life saved. I had created some XXL sized clown shoes to fill. Then came my OR rotation, (after like you having passed hundreds of mannequin tubes) and I realized that its a far more simple procedure than I had made it out to be. Take it slow, and make it smooth.

Fireman1037

I would like to clarify:

The procedure is simple. the implementation is not.

To the OP: READ THE BOOK I RECOMMENDED AND IGNORE THE < deleted the phrase I was going to use> THAT ARE TELLING YOU NOT TO WORRY.

Dont let fear/worry paralyze you, but carry a healthy bit of respect for it none-the-less.

There is a reason why there is a push to remove ETT from the medic nationally, because there are providers not respecting the skill and everything that goes into it. For a "simple procedure" you would think that first pass 50% success rates would be unheard of, but that is where many EMS services "Live". This is unacceptable.

EDUCATE YOURSELF. Period.