Intubation Experiance

Bougie or Bust!!!
 
Chief Complaint said:
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.
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Lol I have one sitting in my apartment from last years EMS Expo, waiting for a power outage.......I used one on a dummy there, it was a nice "adjunct" but think about it, if you can't already see your cords, should you really be passing the tube (where the only the tip is illuminated)?
 
mikie said:
if you can't already see your cords, should you really be passing the tube (where the only the tip is illuminated)?
Click to expand...

If with the bougie, sure, why not? Just confirm placement by other means than direct visualization.

One of my intubations was on a grade 4 patient, yet I felt the clicks, felt the lock, got good EtCO2, good chest rise and good breath sounds.
 
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Linuss said:
If with the bougie, sure, why not? Just confirm placement by other means than direct visualization.

One of my intubations was on a grade 4 patient, yet I felt the clicks, felt the lock, got good EtCO2, good chest rise and good breath sounds.
Click to expand...

I'll second that, I have got tubes when I could not visualize the cords. Even as a last ditch effort if you are not able to feel the rings or see the cords you can shoot for where the cords should be and push the bougie in, if you feel it stop and hit the corina pass the tube confirm with Capnography Breath sounds. If you are pushing it in and it keeps going down down down, you probably in the esophagus, don't pass the tube. Like I said, this is not an exact science and a last ditch method if all else fails before you have to place a king or combitube.
 
mikie said:
Lol I have one sitting in my apartment from last years EMS Expo, waiting for a power outage.......I used one on a dummy there, it was a nice "adjunct" but think about it, if you can't already see your cords, should you really be passing the tube (where the only the tip is illuminated)?
Click to expand...

Tis a good point. I was so enamored by the bright colors that i didnt even think about that!
 
Chief Complaint said:
Tis a good point. I was so enamored by the bright colors that i didnt even think about that!
Click to expand...

It was originally designed for Intubation attempts that did not yield cord visualization, in other words it was originally ment for a Blind Intubation device or Difficult airway device(the bougie that is, not sure about this other thing)
 
Linuss said:
If with the bougie, sure, why not? Just confirm placement by other means than direct visualization.

One of my intubations was on a grade 4 patient, yet I felt the clicks, felt the lock, got good EtCO2, good chest rise and good breath sounds.
Click to expand...

I was referring strickly to the OmniGlow Styette.
 
Fish said:
It was originally designed for Intubation attempts that did not yield cord visualization, in other words it was originally ment for a Blind Intubation device or Difficult airway device(the bougie that is, not sure about this other thing)
Click to expand...

I was referring to the Omniglow Stylite.

The bougie is a great tool, have yet to use one though.
 
Is anyone familiar with the LEMON score for difficult airways? I've been trying to self teach myself and although I can find out what the components of LEMON are and how to evaluate them, I don't know how to score them.

I've determined that the overall score is 10, but is 10 a good airway or a bad one?

Does each letter get a score of 0, 1, 2 or are they scored differently like the GCS.

Is the lower number a good thing or bad? For example, if a Mallampati is level IV, is that a score of 2 or 0?
 
I had never been taught it with a score, but more an evaluation as to the proposed difficulty.

L-Look- facial trauma, large incisors, beard or moustache, and large tongue? (Max of 4 points)
E-Evaluate- 3-3-2 rule. 3 fingers fit in mouth opening? 3 fingers from tip of chin to neck? 2 fingers from mouth to thyroid? (max of 3 points)
M-Mallampatti- This is where the grades come in...1,2,3 or 4? (1pt)
O-Obstruction- False teeth? etc (1pt)
N-Neck- How is the neck mobility? Good? Stiff? Obese patient? (1pt)




It's scored out of 10. A score of 5 or higher is claimed to be a difficult intubation. You assign one point for each of the items listed above that are not "optimal". IE if you can only do 3/1/1, they would get a score of 2 for the E section.
 
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I am a Paramedic student and have been to the OR twice and have yet to get a successful intubation. I am going back again on the 31st to attempt again :D Maybe Halloween day will bring me luck haha My advice keep trying you will eventually get there. I agree its easily learned yet hard to master!!
 
My last OR rotation I had a patient with a difficult airway, the anesthesiologist with me then gave it a try with their mac 3 (which is what they seem to like), then he called for a c-mac glide scope (laryngascope with a very small camerac attached, being viewed on a small monitor, pretty sweet actually) was struggling with that, so he called for a fiibrscope or something like that, he finally got it with the c-mac. So just goes to show you this Doctor whose been practicing awhile even has a difficult time every now and then. My instructor has told me if you can't get a tube bag the patient, they don't die from lack of being intubated but rather a lack of oxygen. The anesthesiologist even told me the same thing!! ^_^. To this day I have been to the OR twice and still have not gotten a successfull tube, although I was close last time. I am going back soon, to try a third time. It doesnt' benefit me being at a universty's teaching hospital. Like everyone said its an easy skill to learn, but hard to master.
 
I'm curious how many intubation attempts you've made. If you've been to the OR twice, and not competed a successful intubation, perhaps you need some additional instruction in technique. How many mannequin or simulator intubations have you performed? Are you familiar with all of the anatomy? Were you given the opportunity to use a bougie if you couldn't visualize the cords? Did you get assistance in fine tuning your technique from the anesthesiologist?

Seriously, 2 shots at the OR is all many paramedic students get, you should be. Using every minute there to work on this low frequency, high acuity skill.
 
N7's comment about low frequency, high acuity made me wonder: how many intubations are people performing per week? Or should it be month/year? It's pretty relevant to this thread, so would people like to chime in?
 
I get in about 6 per year, that probably accounts for my stellar success rate. :)
 
When I was a medic in NJ, I'd get 8-10 per year.

(I worked 16-20 hours per week on average.)
 
Eh, I maybe get two per month, not very many at all.


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