I learned how to intubate today...kinda

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Just as an after meeting deal and realized, its actually quite easy to do as long as you look.


So what makes this an ALS airway? I mean heck, I figured out the basics of how to do it after 10 minutes?


On a brighter side, we got King tubes in today and I'm liking a lot more
 
Doing the skill isn't what is difficult. It's knowing when to do it, and when not to do it, understanding the indications/contraindications and complications of deciding to intubate, etc that is the difficult part. My 5 yo could be taught how to intubate. That doesn't mean he should be allowed to do so.

Depending upon where a medic went to school, some (most??) of them don't even have the education to be intubating. There really is a reason why removing intubation from the medic's scope of practice has been discussed on more than one occassion.
 
Basics get Combis in Michigan already, don't they?
 
Hockey9019 said:
Just as an after meeting deal and realized, its actually quite easy to do as long as you look.


So what makes this an ALS airway? I mean heck, I figured out the basics of how to do it after 10 minutes?


On a brighter side, we got King tubes in today and I'm liking a lot more
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If you have to ask, then that should give you a hint there is something more than you realize or know.....
 
Linuss said:
Basics get Combis in Michigan already, don't they?
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Yes


We're getting King airways. Haven't gotten to play with that yet.


I just thought intubating would be harder then it really was
 
Hockey9019 said:
Yes


We're getting King airways. Haven't gotten to play with that yet.


I just thought intubating would be harder then it really was
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It's not as easy on a human, than it is on a mannequin.
 
Intubating a dummy head is easy.

It is when the patient is biting down, vomiting, bleeding or you spasm the cords that you have serious problems. You know, all the real life stuff.

It is also the follow through to keep that tube in the patient because it is NOT a pleasant adventure for the patient. Patients aren't just going to lay there and let you have your way with them like the near dead that tolerate a combitube.

BTW, did they teach you to assess the airway for degree of difficulty prior this session?
 
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VentMedic said:
Intubating a dummy head is easy.

It is when the patient is biting down, vomiting, bleeding or you spasm the cords that you have serious problems. You know, all the real life stuff.

It is also the follow through to keep that tube in the patient because it is NOT a pleasant adventure for the patient. Patients aren't just going to lay there and let you have your way with them like the near dead that tolerate a combitube.

BTW, did they teach you to assess the airway for degree of difficulty prior this session?
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Nah I was just watching a few people do it and after they were done I just asked for one of them to show me how to do it. It always looks fun watching them do it I had to feel semi-smart for a few :p

I'm sure though as you and others say, its a lot harder on an actual person. I've learned that coming from basic class to real life ;)
 
You also need to realize the consequences of intubating the pt. When you work interfacility, you'll see firsthand how these pts turn out, and generally need longer admission times, to be weaned off of the vent, iatrogenic injuries from intubation, noscomial infections, weakening of the pt's respiratory muscles, and such. I last worked in Charleston SC 4/08, and at that time, the EMT-B's could intubate. It was probably a function of rural txp times.The state was trying to take that away, though.
 
46Young said:
you'll see firsthand how these pts turn out, and generally need longer admission times, to be weaned off of the vent, iatrogenic injuries from intubation, noscomial infections, weakening of the pt's respiratory muscles, and such.
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Those are the luckier ones. Some end up with a trach and peg from the damage. They may also need a mechanical speech device. The CombiTube is also starting to get notice for its complications. Much of it is probably due to lack of training about the device and anatomy.

The damage from ETI is also often caused by ego problems. Some will try repeatedly to get the tube in. Some were never taught how to assess an airway or use an intubation score. There are some that would rather rip a throat or palate rather than use a BVM or an alternative airway. But, those that finally get an ETT into what's left of the throat will not admit to how many times they attempted. Thus, the data for successful intubation is often skewed even though the tube made it somehow through the cords.
 
46Young said:
I last worked in Charleston SC 4/08, and at that time, the EMT-B's could intubate. It was probably a function of rural txp times.The state was trying to take that away, though.
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Indeedy, I believe they took this away finally at the end of the year. Or early this year. At least, I know the SC services in the Augusta, GA / N. Augusta, SC area can no longer do it on the basic level and I was under the assumption that was a state wide change.

It really does make sense though as everyone has been saying, intubation can be learned like any other skill but it does require a deeper knowledge of the concept which simply aren't being taught to the EMTBs just yet. Nor to the EMT-I's really. At least not around SC or GA from what I've seen.

-----back to OP-----

It is nice to visualize the skill and see how to do it early on. I know getting all the time I could to practice routines and proceedures was a great help to me, so make use of the newly founded skill! (on dummys, obviously, the ones that won't sue you or fight back) Now to learn the context of intubation...
 
VentMedic said:
Those are the luckier ones. Some end up with a trach and peg from the damage. They may also need a mechanical speech device. The CombiTube is also starting to get notice for its complications. Much of it is probably due to lack of training about the device and anatomy.

The damage from ETI is also often caused by ego problems. Some will try repeatedly to get the tube in. Some were never taught how to assess an airway or use an intubation score. There are some that would rather rip a throat or palate rather than use a BVM or an alternative airway. But, those that finally get an ETT into what's left of the throat will not admit to how many times they attempted. Thus, the data for successful intubation is often skewed even though the tube made it somehow through the cords.
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That reminds me of the time the BLS had an unconscious head trauma pt packaged appropriately with spinal motion restriction procedures, on O2 15lpm NRB. Unresponsive, BP 130/70 or so, 80P, 16RR, skin normal CTC, L/S CTA bilat, all reported by BLS, and confirmed by us. SPO2 100%, RSR, no glucometer available, ETOH on breath. I was a new medic at the time, asked repeatedly to leave for the hosp. My partner refused, and had me draw up etomidate and lidocaine, per protocol, for intubation. After about one continuous minute of an intubation attempt(I know), my partner withdrew a bloody tube, and we were finally able to leave the scene about 15 minutes after our arrival. During an arrest, This same guy kept dumping epi and atropine down the tube every few minutes, even though most of it was coming back up.
 
That's a pretty messed up partner, what the heck? Talk about turning a bad situation into a worse one.
 
simpatico said:
Indeedy, I believe they took this away finally at the end of the year. Or early this year. At least, I know the SC services in the Augusta, GA / N. Augusta, SC area can no longer do it on the basic level and I was under the assumption that was a state wide change.

It really does make sense though as everyone has been saying, intubation can be learned like any other skill but it does require a deeper knowledge of the concept which simply aren't being taught to the EMTBs just yet. Nor to the EMT-I's really. At least not around SC or GA from what I've seen.

-----back to OP-----

It is nice to visualize the skill and see how to do it early on. I know getting all the time I could to practice routines and proceedures was a great help to me, so make use of the newly founded skill! (on dummys, obviously, the ones that won't sue you or fight back) Now to learn the context of intubation...
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Yes, SC did take Intubation away from the Basics and "I's" starting Jan. 1 2009. Boy, did the crap hit the fan over that. I was proud of the state, to take that stand and stick to it.
 
It seems like everything is easier to do on a dummy! They aren't puking on you,hitting you,bleeding on you... :rolleyes:
 
traumaqueen63 said:
It seems like everything is easier to do on a dummy! They aren't puking on you,hitting you,bleeding on you... :rolleyes:
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I would hope they are not trying to hit you, if you are trying to intubate them!;)
 
simpatico said:
That's a pretty messed up partner, what the heck? Talk about turning a bad situation into a worse one.
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I was in fear of losing my card every time I camr to work. I eventually had enough of him, put the fear of god into him, and he straightened up.
 
46Young said:
I was in fear of losing my card every time I camr to work. I eventually had enough of him, put the fear of god into him, and he straightened up.
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I would have reported him to superiors. Someone like that has no business working in EMS, fire or not.
 
I basically told him that this lousy pt care can't continue, that I will get him fired, and that if I lose my livelihood, he will be dealt with when no one's around to witness.
 
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