Intubation Experiance

mikie

mikie

Forum Lurker
Messages
1,071
Reaction score
1
Points
36
When you first started intubation (which maybe a LONG time ago from some of you geezers :) ) , field/clinical/OR, wherever; were you successful, unsuccessful? Found it easy, difficult? At what point in time did it take you to "think" you were competent in ETI?

Obviously every patient has different airway anatomies and circumstances surrounding the reason for intubation, I'm just looking for some general impressions, per se.

thanks!
 
Intubations are like IV's. It is a skill that is easy to learn, hard to master. I have been told to my face and overheard some brag that they haven't missed a tube. Either they are lying or not as experienced as they would like or think. Because the operative word in that phrase is "yet".

I've been intubating since 1992. I have gotten tubes some would never get and I have missed tubes some would never miss. I have acquired enough experience to be comfortable enough to admit I may need help on some difficult airways. I don't consider myself good, reliable, or whatever. All I can say is that I'm experienced.

When did I begin to feel comfortable on airway? Can't say. That's a blur.
 
I missed the first couple intubations in the OR, but then I finally relaxed and went a little more slowly, and my success rate shot up. I can't say I really found it to be difficult, nor easy, it just depends on the patient. I think I'm decent at intubation, but I still have a long way to go before I feel like I would be competent in intubation.
 
I have 3 field intubations, 2 of which were RSIs. 100% first pass success rate.




Still don't think I'm competent at it... just lucky, despite the grade 3/4 airways I've had.
 
Linuss said:
Hey, just like the EZ-IO, I have no issue using the bougie on the first attempt if I think it will help. ^_^
Click to expand...

I know, just hasslin'. I didn't have it available for my attempts and haven't had much practice with it (we were drilled on stylettes). Though using on a simman recently it does seem to be easier (with an additional set of hands)
 
If a bougie improves intubation rates, is there any reason not to use one?

If a bougie would improve intubation rates when used as a matter of practice, how is not using one, as a matter of practice, anything other than malpractice?

If a bougie would improve intubation rates when used as a matter of practice, shouldn't services be held liable for putting their patients needlessly at an increased risk?

/Channeling my inner-Roguemedic.
 
Last edited by a moderator:
JPINFV said:
If a bougie improves intubation rates, is there any reason not to use one?
Click to expand...

Yes, there is...because we don't carry them :(
 
My last agency required bougies to be used on the first attempt after internal studies showed massive first pass success rates getting increased.


The stylettes were backup (we carried adult and pedi bougies)
 
I missed my first real one in the OR back in 1993 and haven't missed one since. I'm still not competent. :)
 
In the 80s I first learned with an anesthesiologist, who happened to be our medical director. After playing with plastic, he brought me to the OR and we went over the gadgets. My first view inside was just that... a view. He had me look in under direct laryngoscopy and describe the structures, position, etc. After about 20 seconds, I pulled out and did a a little BVM. Then back to viewing the structures again, gently moving around and getting comfortable with the sights. Another round of BVM vents, and then I passed the tube.
Memorable as if it were yesterday.
After that, we would go over "what-ifs" and "what would you do" scenarios. I did about 10 intubations that day.
Over the years, I stopped documenting tubes as a supplemental log after 100 in the field somewhere around 93/94. Since then its just been on the PPCRs and a couple or so for re-registry. I feel quite comfortable with them, and like to hum a tune while doing it now, maybe some sound effects or something. :P
I love that tube... and will always fight to keep it in our profession. No doubt.
 
mikie said:
You cheated and used a bougie :P jk, that's awesome!


and thanks for the replies
Click to expand...

If it secures an airway, there is no such thing as cheating. Ego is the quickest way to :censored::censored::censored::censored: up an otherwise recoverable failed airway scenario (or get yourself into one in the first place).
 
usafmedic45 said:
If it secures an airway, there is no such thing as cheating. Ego is the quickest way to :censored::censored::censored::censored: up an otherwise recoverable failed airway scenario (or get yourself into one in the first place).
Click to expand...

Agreed.

Don't think of it so much as "cheating" as it is a "helping tool". We have a multitude of tools and techniques that we can use to secure an airway, and we have such a plethora of options because everyone's airway is different. Don't be afraid to go straight to the bougie if you predict it to be a difficult airway, and my the same measure, don't be afraid to go to your backup airway.

However, lately I've had two Kings that I just couldn't ventilate through, it must be me :P
 
I've been a medic for just under 2 years and have 7 RSIs and about 15 tubes in the field, all told. Everyone still makes me nervous. Preperation is the key.

And I use a bougie 90% of the time.

And I'm only baseline competent.
 
what is a bougie?
 
Think of an extra long stylet that is designed so that the stylet is introduced into the trachea first, confirmed by feeling the cartilaginous rings circling the trachea, then the ET tube is slide down the bougie and into the trachea.

bougieKiwiGrip_01.gif


It can be used both both with a larygnoscope or as a blind technique.
 
You'll feel the tracheal clicks AND hopefully tracheal lock when the tip of the bougie hits the carina and sticks on the right mainstem.
 
Has anyone ever used one of these? Seems gimmicky at first, but who doesnt like a little extra light in there? FF to 1:58 to see it in action.

[youtube]WBBoEmObqX4[/youtube]
 
At my previous Service, the Bougie was an option and we only used it on difficult airways. At my current service we do not even have stylettes. It is Bougie all the way, the increase in success with a Bougie shown in studies was so large that it only seemed reasonable to make this the standard. I have never missed with a Bougie, have missed maybe 4 times with a stylette? However 2 of them required an ant. to come down from the OR to intubate in the ER as the ER Doc could not place the tube either. Also we added the LED Larygnoscope Blades, when you add this super bright blade with the Bouge it is almost impossible to miss! And that Bougie works even when you can't see the Cords due to anatomy or Blood/Vomit/Etc.
 
You must log in or register to reply here.
Back
Top