What was your first intubation like? (Clinical setting)

[TattooedNay]

I have made it through the didactic portion of medic school. yyyyaaaaaaaaayyy...(so enthusiastic) I am starting my clinical rotation tomorrow, and have my first OR shift scheduled. I work in the same hospital as a tech in the ED, so I introduced myself to the staff and anesthesiologists last week. They pulled up the schedule and said there are three ETT's and an LMA scheduled. I am excited and extremely nervous. What was your first intubation and clinical experience like? Any tips so I am not a wreck and vomit/pass out from anxiety?

 

[NomadicMedic]

My first OR tube was a very skinny male, it was like tubing Fred the head. Next OR tube was an obese woman. I had an attempt, no luck. The CRNA also couldn't get the tube. Chief of the department came in and got it on the 2nd try with VL. It turned into a great teaching moment. I later had the opportunity to spend several days with the Chief and he lead me through 20+ intubations, teaching all the way. One of the best experiences of medic school. I understand the medic program I attended no longer has a relationship with that hospital, which is a shame.

First field tube as a student was an arrest, no issues. First ED tube was an arrest, no issue. First field tube as a solo medic was an RSI. No issues. I've had several difficult/unsuccessful intubations since then and learn from each one.

 

[joshrunkle35]

I scheduled, I think, 10 or 20 in the OR during medic school. My first few were unsuccessful, but the CRNA was unsuccessful as well. The third patient was a teenage girl who I got immediately. All of mine were successful after that. The biggest difference was that in school, I had cranked down on the mannequin's head. That doesn't work on real people, as their airway moves anterior when their head gets cranked back. The CRNAs put a pillow under the head, whereas I had learned to rip a pillow away and crank the head back, which is just really bad technique.

 

[PotatoMedic]

Well, first I had lots of practice on the fake head. Just drilling in positioning, padding, inserting technique, yada yada yada.

My first intubation was my very first field shift and I ended up using a video laryngoscope. My next intubation was an arrest that I got first pass on. And the next few handfuls have been at the OR where some of the docs like students and others no. But all that have been willing to take students have been very helpful and willing to teach on every single one.

 

[hogwiley]

My first OR intubations were much more stressful than my first one in the field, mainly because they were younger and I saw them while they were awake so it seemed to add more pressure, and you're under the gun to get your required intubations in a limited number of shifts. I still managed to get my first 3 no problem until I ran into a tough one I had to tap out on and let the CRNA do.

 

[chaz90]

I did my first live (well, cardiac arrest) intubation during an ED shift. I heard the incoming "Code Blue" announcement over the loudspeaker and scurried across the hospital from the cath lab like a laser guided intubation seeking missile. I went in and spoke to the ED doc who I had importantly already introduced myself to earlier and he was more than happy to let me intubate. Easy one pass intubation with direct laryngoscopy that gave me some early confidence. I had a bunch more in the OR, which were probably even more helpful due to the experts watching and critiquing every aspect of airway management.

 

[DesertMedic66]

17 year old in the OR who was getting his collar bone set. Got to talk to him before he went under. It was weird just because I was not used to the OR atmosphere. It went smoothly.

 

[TattooedNay]

Wow... so the OR is insane and I absolutely loved it. I found the CRNA's to be much more helpful than some of the Anesthesiologists. Really the only "issue" I had was having residents trying to take my cases. It really is so different than mannequins (obviously) and what we are taught in classroom. We are taught to go go go go hurry up we have 30 seconds so when I was in the OR and they said "take your time" and "let go of the tube" I cringed. Also I learned how hard and imperative a good mask seal really is! Seeing all those numbers on the monitors put everything together. Once the paralytic was administered seeing the etco2 flatline was woah. Anyway, thanks for the stories! I'm excited to schedule more time.

Also being a CRNA seems like a pretty sweet gig.

 

[hogwiley]

Wow... so the OR is insane and I absolutely loved it. I found the CRNA's to be much more helpful than some of the Anesthesiologists. Really the only "issue" I had was having residents trying to take my cases. It really is so different than mannequins (obviously) and what we are taught in classroom. We are taught to go go go go hurry up we have 30 seconds so when I was in the OR and they said "take your time" and "let go of the tube" I cringed. Also I learned how hard and imperative a good mask seal really is! Seeing all those numbers on the monitors put everything together. Once the paralytic was administered seeing the etco2 flatline was woah. Anyway, thanks for the stories! I'm excited to schedule more time.

Also being a CRNA seems like a pretty sweet gig.

CRNA's really are rock stars of the medical world. Just an amazing combination of skill, knowledge and coolness under fire.

Your OR rotation seemed like my first one. Practice bagging the patients was really valuable. So often in the field(and the ER) people do a poor job of it and don't always realize it, but we couldn't fool the CRNAs and anesthesiologists, they made sure we understood how to do it right and how valuable it can be if you do it right. There may be situations where you may have a hard time getting an advanced airway and getting a good mask seal and bagging the patient becomes a crucial skill.