Retaining skills - intubation et al.

Seirende

Seirende

Washed Up Paramedic/ EMT Dropout
Messages
892
Reaction score
430
Points
63
So if I start bugging y'all with a multitude of naive questions, let me know. Not that I'll stop asking or anything like that.

I was reading another thread about returning to a license level that one had formerly, which got me thinking. I'm making a mental inventory of skills that might suffer from a hiatus of approx. one year from 911 ALS. Really the only one that comes to mind is intubation. I'm not too worried about the cardiac monitor and IVs. Needle decompression, cricothyrotomies, and IOs are only able to be practiced on mannequins anyway. With intubation however, I found the difference between plastic and patient to be considerable enough to cause me to hesitate before claiming competency in that skill after over 1 year with my only experience being two misses followed by three successes in the OR.

What would you recommend to someone whose intubation or other skill was in doubt? Is there the possibility to repeat OR time? Should I try to sneak tubes down people's throats while they're sleeping? (Snoring respirations, right?)

Are there other forms of ALS skill decay that I should be watchful for?
 
I intubate a fair amount of people annually (911 service with RSI + Flight team + mandatory annual OR + Cadaver Labs) and would never claim to be any kind of airway expert. I feel I have achieved a degree of competency, that's all. The problem is that the truly difficult airway is rare. Often airways that are considered difficult are actually fairly typical airways managed poorly.

I think you are right on point to be concerned about decline of this essential skill (if only because performing it poorly can have such negative consequences).

Here's my thinking on your situation,

1. OR time is difficult to find without a program with connections to a hospital. If you can get in , go for it. It's always best to intubate real live patients under the direction of actual airway experts.

2. Airway heads are ok for basic muscle memory and practicing timing , but I think even the more expensive ones just aren't that great. That being said, it's super important to rigorously practice setting up equipment , back up equipment, suction , 02 etc. Verbalize what you are going to say to your partner / other providers. Practice drawing up meds, sedation, etc. This is all 100 percent essential.

3. Do you use a bougie or a video laryngoscope? If I DL I use a bougie every single time. I also use video systems some of the time. The technique is diferent but I believe both can be of service to novices in airway management. And make no mistake, that's you. No offense is meant, but make sure you realize this.

4. I think watching airway / intubation videos is very helpful. You become used to seeing the progression of the anatomy. I think it's better than tubing the same head endlessly.

5. Make sure you are calm and cool when you intubate. Don't rush, don't forget to optimize hemodynamics and pre - oxygenation. Make that first attempt count. Make sure you have studied up on good positioning and technique before hand (how to open the mouth, how to use an assistant for external manipulation etc). Focus on finding the epiglottis. This will help orient you. You may not see the vocal cords at all. The bougie is helpful in this situation.

6. There are some courses available, usually with airway heads but they may offer some good tips.

7. Seek out criticism and help from those you work with who have more experience. I ask Docs and CRNA s at the OR to really let me have it. It's not enough to pass the ETT. How was my thinking on meds, choice of device, bagging technique, mouth opening, etc etc. Don't get upset if you get told you need to improve. Embrace it.


Good luck.
 
Last edited:
You must log in or register to reply here.
Back
Top