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I can't put a number range on it since I frankly don't know. And yes many place has gas place the tube.
Sorry for hijacking, but why would places have anesthesia come place the tube? I mean, I know supposedly they are the airway experts and all, but I would assume that IM trained intensivists are perfectly capable of airway management, even for more difficult cases. Just seems like it would be easier to not bother with anesthesia, who I imagine is running the OR/managing the SICU anyway.
Sorry for hijacking, but why would places have anesthesia come place the tube? I mean, I know supposedly they are the airway experts and all, but I would assume that IM trained intensivists are perfectly capable of airway management, even for more difficult cases. Just seems like it would be easier to not bother with anesthesia, who I imagine is running the OR/managing the SICU anyway.
but I would assume that IM trained intensivists are perfectly capable of airway management,
mistake one was to think hospital politics make sense, mistake two is to assume all IM trained intensivists are trained adequately in airway management. There is placing a tube, and then there's placing a tube. I'd argue my program is horribly inadequate in airway management education, and if it weren't for comfort level from my IM program, I'd be a pansy as an attending. That being said, I also don't have much respect for the gas-passers' at my hospitals management of ICU airways. There are only 2 attendings who approach it in a manner that I think is appropriate. Most walk in and act like its no big deal, they have next to no difficult airway equipment with them, but it's actually the CRNAs who do most of the airways (I do my own when I can, which means only when I have an attending in house). But I've even had a gas attending admit on one of the bloodiest cases that we were better off letting the nurse try since he does more tubes than the attending yeah, that's a real captain of the airway ship. I'm waiting for the day when in the middle of the night they get in over their heads and loose an airway and trauma doesn't get there soon enough to cric since yet again, I'm not allowed to do that without my attendings present.
I'm usually pretty damn cocky when it comes to procedures, but in my mind the airway is different. If you don't have a healthy level of respect, it can and will bite you in the ass and someone will get hurt.
I would be interested to hear what things are being done (or not done) that makes you feel the anesthesiologists are mismanaging the airway.
1) It's next to never the anesthiologist, or the resident, it's almost always the crna. I do hate to watch a nurse do my procedures.
2) theyre never prepared, don't have suction, don't check the tube, rarey ask about labs, don't pre-oxygenate have no difficult airway equipment ready, when they get in over thier heads, it takes many minutes for them to run to OR to get their glidescope (yes, I've complained that we don't have our own)
3) as above, I had a pt in DIC need a tube, it was a bloody ****ing mess, and the attending looked scared and admitted that we'd be better off letting the crna keep trying since he did more intubations than him
4) I once had a anesthiologist leave the unit and left me without an airway before trauma shows up for a cric, without trying.....after he proceeded to lecture me that PCV pts must be paralyzed and berating me as to why this pt wasn't on APRV (hint, he was hypercapnic as ****)
5) that being said, they also have 2 of the better attendings I've seen with airways, But it isn't them on too often.
I don't consider myself lucky to have a nurse do my job. I'm irritated that as a critical care fellow I should be doing all my airways.
Politics aside, let's face it, even emergent intubations rarely fall into the nearly dead/ newly dead type of airway that demands action without preparation
I commend your sense of responsibility.
I commend your sense of responsibility. I wish all critical care physicians would do their own airways. But in every hospital I've been at, they almost never do.
You can do everyone a favor by doing your own airways when you go into practice. But based on my experience, a nurse will be doing your airways (or maybe even a RT).