# advice for intubation technique??



## FutureFlightMedic (Oct 25, 2006)

Hi, everyone. I just got back from paramedic class lab tonight. We went over intubation skills with a brand new manequin. I had no problems with intubation last week on the old manequins, but tonight I just could not get the tube in. With this new one, you can only visualize the cords if you are standing on your head! (I tried to contort my body enough, and sure enough I saw them, but the lab assistant said it was poor technique.) I tried kneeling down, but I am not tall enough, so I couldn't even see in the mouth! The lab assistant even said this manequin is extremely difficult, and lots of people had problems with it. The biggest issue for me is, my instructor was using this lab as an indicator of who is ready to go to the O.R. to start actual intubations. Now I feel like everyone thinks I suck! (lots of guys even stayed behind to give me helpful advice, and I tried to take it, but still couldn't sink the tube and eventually just got annoyed-at myself, not them) Now, all my arm muscles are sore, I stayed late, and got nowhere. I wanted just one succesful intubation before going home so I'd know I could do it! I didn't even get the chance to fully complete that station. With 12 people in lab and one manequin head that's not very good odds. Does this mean I am always going to struggle with this? I am a smaller girl in stature but I want to learn and be excellent at this. Does anyone have advice for me?


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## Guardian (Oct 25, 2006)

Practice a lot would be my only advice.  This sounds like a good learning opportunity for you.  I've seen some petite women over the years who could intubate better than me (6'3, ~230lbs) so you'll be fine.  Also, don't over do it, just lift that tongue up just enough to see the glottic opening which isn't very much.


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## Jon (Oct 25, 2006)

Practice, practice, practice.

Did you try selleck's manuver? That sometimes helps.


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## Flight-LP (Oct 25, 2006)

A plastic mannequin is no indication of any remote level of intubation ability. Your instructor is a moron if he uses it as an indicator to go to the OR, i.e. the most simplistic and controlled environment you will ever intubate in. Don't let this plastic dummy get you down, go to the OR and focus on your technique. A solid technique and effective assessment will provide you with success, shoving a tube into a plastic dummy does not. Remember your LEMON and BURP mnemonics (and if these haven't been taught to you, a. your instructor is more of a moron that previously stated and b. none of you have any business intubating anything until these principles are taught)........

Also remember your adjuncts that can assist you.............

Eschmann Tracheal Tube Introducer a.k.a. the Bougie
Combitube
LMA

3 attempts then go to a failed airway.......

Regardless of the type of airway, if the sats are less than 90% and you have difficulty ventilating, cric or trach 'em.

Good luck to you !!!


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## Airwaygoddess (Oct 25, 2006)

Is the airway manikin on a table, or on the ground like a real victim would be?
ask the teacher if lubricant can be used. With most of the new airway trainers, the manufacturer's directions state that lubricant must be used.
Also, have you tried laying down on your stomach at the head to get a better view? maybe that might help also.  Hang in there! you will get it!!!!


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## Guardian (Oct 25, 2006)

Flight-LP said:


> A plastic mannequin is no indication of any remote level of intubation ability. Your instructor is a moron if he uses it as an indicator to go to the OR, i.e. the most simplistic and controlled environment you will ever intubate in. Don't let this plastic dummy get you down, go to the OR and focus on your technique. A solid technique and effective assessment will provide you with success, shoving a tube into a plastic dummy does not. Remember your LEMON and BURP mnemonics (and if these haven't been taught to you, a. your instructor is more of a moron that previously stated and b. none of you have any business intubating anything until these principles are taught)........
> 
> Also remember your adjuncts that can assist you.............
> 
> ...



Do you know of a link where I can learn more about LEMON?


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## Guardian (Oct 25, 2006)

I don't remember learning the lemon mnemonic.  I guess with all my years in ems, I don't have any business intubating :sad:


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## Flight-LP (Oct 28, 2006)

Here you are.............

http://emj.bmjjournals.com/content/vol22/issue2/images/large/em8771.f1.jpeg

http://emj.bmjjournals.com/cgi/content/full/22/2/99

http://www.anesth.uiowa.edu/Uploads/LEMONAIRWAYEVAL.htm


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