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sgoemt

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I want to start out by saying hello to all members. I've lurked this site off and on for awhile, and finally registered. I've been an EMT for about 7 years now, and am 1/2 way through medic school. We started clinical rotations about 3 weeks ago, and so far all is going well, except for a couple areas. IV wise, I do great in the field, but not so hot in the ER. I started to inspect the angio's, and noticed that the ones in the ER have about 3/16ths of an inch from the needle to the cath, while the ones on the ambulance have about 1/16th of an inch difference. That explained why I kept blowing veins the first few times at each location. Too much pressure on one, not enough on the other.

Yesterday I had my first OR rotation so I could get my intubations. the first one I visualized, but didnt go far enough in. When the cuff was inflated, it pushed it out of the cords. The second one I got. The last one had a short neck, and I was afraid of applying too much pressure.....and then fear set in. I realized it wasnt the classroom dummy, but a live pt. Which leads me to the reason of my registering and posting. Is it normal for a new student too put too much pressure on themselves? I'm a diehard perfectionist, and it bothers me when I don't get a procedure correct. My instructor told me that it's natural, and that it'll come with practice, but now I have this nagging fear in the back of my mind. I don't wanna puncture the throat or cause injury. Did any of you have the same problem when starting clinicals? I don't want to pull constant A's in the classroom just to find out I can't do the procedures. Any advice or critiques are welcome, and hoped for.
 
Perfectionism can only benefit--- you will strive to do better.



Remember how you felt in EMT clinicals?
 
Perfectionism is a wonderful thing and the pressure is normal. Trust me I would worry myself physically ill before anything major happened in class. It is alot harder in a hospital setting to do procedures, at least it was for me, because I had time to think. When I did, and still do, something and it was out in the field I didn't have time to think and instinct kicked in. In the hospital you have time to over think and on top of that have people staring at you and waiting for you to screw up makes being a perfectionist hard. Don't worry it will pass in time. Remember everyone had to start somewhere and have screwed up at some point. ^_^
 
sgoemt said:
Yesterday I had my first OR rotation so I could get my intubations. the first one I visualized, but didnt go far enough in. When the cuff was inflated, it pushed it out of the cords. The second one I got. The last one had a short neck, and I was afraid of applying too much pressure.....and then fear set in. I realized it wasnt the classroom dummy, but a live pt. Which leads me to the reason of my registering and posting.
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When intubating, do a thorough assessment with an airway difficulty score. Approach it as you would any complex job be it capentry or medicine. If you have a physician there, ask what issues they would expect when intubating the patient. An Anesthesiologist will have already done their assessment long before the patient gets into the OR which is also why their success rate on the first attempt is very high. See if they assess the patient's airway potential the same as you. Also, look at the length of the neck, the sternal notch and length of chest and abdomen placement to visualize the carina position to give you an idea about tube depth. I usually will place my fingers just above where I predict the correct depth and will not take my eyes off the tube as it passes through the cords. Too many raise their eyes too soon and the tube follows but then they attempt to continue advancing blind. If you get caught up with this preparation, you shouldn't be stressed for the procedure as you will have a game plan with potential issues expected.
 
Thank you VentMedic! I hadn't really thought about that. It was nerve racking having all the OR staff and surgeon just standing there, watching me. I will definitely use your advice. Maybe if the staff sees me assess, along with my concentrating on the pt, I'll be more successful. I have a couple other questions if you don't mind. Is it possible for me to advance the laryngoscope TO deep, thereby causing me to overlap the cords? And is it normal for the blade to seem like it's taking up all the room in the mouth?
 
just remember my favorite movie quote "Everything's going to be all right" Seriously, just go through your processes and you'll be ok. Come ride with me in the hood.
 
Thanks Firespec!! May take you up on that someday!

BTW, got THREE intubations the other day!! OR of course, but the CRNA said they were flawless!! So I'm a happy little student today ^_^
 
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