Am I too physically weak for anesthesia?

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CaMD

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I'm a (short, female) medical student doing an anesthesia rotation and I am having a lot of trouble both ventilating and using the laryngoscope on large men.

1. In order to get a good seal with the mask and lift the mandible I need 2 hands, one on each side. That leaves no hand free to squeeze the bag.

2. I'm having a heck of a time lifting the larygoscope on big guys (but I'm a pro with little old men with no teeth. 😉 ). I can do it with two hands, but not with one. Once again, another hand to hold the ET might be nice.

Do I just suck? Am I weaker than I thought? Or do you have any helpful hints on ways to better leverage myself?

Thanks, guys.
 
One of our CRNAs is a five foot tall girl that weighs 90 pounds......actually she's pregnant now and is freaking out because she just eclipsed a triple digit weight for the first time in her life. :laugh:

She's good at what she does.

If she can do it, you can too.

Just takes practice.

Lower the bed to your height. On big dudes put some towels behind their shoulders to maximize neck extension if you're using a Miller. Alot of little tricks you can learn to make up for your petiteness.

Keep trying.

Good luck.
 
Technique grasshoppa...

Try bracing your left elbow on your ileac crest, keep your arm in the same place and lift with your legs instead of your arm. The table will have to be at the right height.
 
Hold the ett with your teeth. Get close and intubate.
 
Don't worry, with experience you will realize that you need less strength to do laryngoscopy, it's really not about force (in the ER it is) it's more about putting both the blade and the patient in their optimal locations.
 
One of our petite SRNAs had the same problem until she got implants. Now she just rests the patient's head on her new acquisitions when she goes in for a DL which gives her a free hand. No lie. She's quickly become a legend among surgical and anesthesia residents. Just a thought....
 
Bougie said:
One of our petite SRNAs had the same problem until she got implants. Now she just rests the patient's head on her new acquisitions when she goes in for a DL which gives her a free hand. No lie. She's quickly become a legend among surgical and anesthesia residents. Just a thought....
Click to expand...

HAHAHAHAHAHAHAHAHAHAHA

"Going to CRNA school, $60,000."

"Amount for psychologic debriefing for inability to perform at work, $5000"

"Buying implants which enables you to intubate,"


"PRICELESS."
 
If we did the same with our nuts we would pervs.

Anyway, seems like the pts are in good company.
 
Apollyon said:
If a tree falls in the woods, is it a true thread on SDN if someone doesn't rip on EM?
Click to expand...

I think he meant force as in "The Force", because we all know you guys are Jedi Masters.

-copro
 
SO everyone is encouraging here, except those that are perseverating.

I guess I'll have to put in my $.02.

Yes you will have trouble and you will never really get over it. But you can learn to minimize the times that you struggle. There will be airways that you can't handle b/c of shear strength. But this doesn't mean that you can't be an anesthesiologist.

Good Luck
 
coprolalia said:
Is "perseverate" even a real word, or just one of the many neologisms invented by pompous scientists? I think this is similar to people who've bastardized going to orientation into "orientate". Or, maybe it's just that we all need to return to a sense of normalcy. :laugh:

-copro
Click to expand...

Copro, what's the correct word: dilatation or dilation? I always thought it was the latter.

Anyway to reply to the original poster, I'm not the strongest person. I certainly don't have the largest hands. I struggled as a med. student. But, cross my fingers, I haven't missed an airway in the recent past. Positioning cannot be overemphasized. As a CA-2 I intubated a 227 kg man, with a Mac 3. Because we positioned him properly, it was one of the easiest intubations I've done. Force has little to do with it. Keep practicing.

Although admittedly once I've had a Class 3 view become class 2 when my attending, instead of giving me BURP/cricoid as I requested, grabbed the top of the laryngoscope handle and just lifted upwards.
 
CaMD said:
1. In order to get a good seal with the mask and lift the mandible I need 2 hands, one on each side. That leaves no hand free to squeeze the bag.
Click to expand...

Make use of that headstrap - that's what it's for. Left hand to hold down left side of mask and jawlift, headstrap to hold down right side of mask, right hand bagging. If you pop in an oral airway, you don't even need very much jawlift most of the time - and if you do, probably shouldn't be doing asleep DL anyway.
 
Don't make life so difficult: Set your ventilator to 16-20 RR, TV to 700-800, turn it on with high flow oxygen and slap the mask on and hold with two hands. That's what you do in private practice with no one around to give you an assist on a tough airway and it works very well for normal airways.
 
coprolalia said:
Is "perseverate" even a real word, or just one of the many neologisms invented by pompous scientists? I think this is similar to people who've bastardized going to orientation into "orientate". Or, maybe it's just that we all need to return to a sense of normalcy. :laugh:

-copro
Click to expand...

The guy(?) has been going on about the single same thing for almost 5 years now - exclusively. I think that fits the definition.
 
Apollyon said:
The guy(?) has been going on about the single same thing for almost 5 years now - exclusively. I think that fits the definition.
Click to expand...

Is this kinda like the guy that says

"LOOK, I'M DONE CONVERSATING WITH YOU." :laugh:

God knows its time to stop conversating about an issue.
 
UTSouthwestern said:
Don't make life so difficult: Set your ventilator to 16-20 RR, TV to 700-800, turn it on with high flow oxygen and slap the mask on and hold with two hands. That's what you do in private practice with no one around to give you an assist on a tough airway and it works very well for normal airways.
Click to expand...

excellent tip. gonna try this next time. thanks UT!
 
UTSouthwestern said:
Don't make life so difficult: Set your ventilator to 16-20 RR, TV to 700-800, turn it on with high flow oxygen and slap the mask on and hold with two hands. That's what you do in private practice with no one around to give you an assist on a tough airway and it works very well for normal airways.
Click to expand...

One of my peds anesthesia attendings taught me something similar -- except he taught me to use pressure control. Set the pressure at 18-20.

It really helped one time after an attending extubated a robotic prostate (ours take 4-5 hrs), and left me to deal with a very sleepy edematous patient. I had to assist his resps, because otherwise he would desat. We got a BiPAP machine for him in recovery.
 
Good technique is more important.

That being said, if you are worried about strength, just hit the gym and buff up those arms and forearms. Being in good shape and strong only helps and once in a while you do have to fight some rowdy teenager waking up or get in wierd positions to put in an IV upside down.
 
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