having a very difficult time intubating!

[Narcotized]

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[Narcotized]

ps- If you're still having trouble intubating, it's probably Obama's fault.

 

[Sergio99]

It doesn't matter how you open the mouth, actually tilting the head back will effectively open the mouth for you enough (in most patients) to insert your blade, but if you have a patient with an anterior airway it really helps if you could subluxate the mandible before you insert the blade and the easiest way to achieve that maximal mouth opening is with the fingers in the the right corner of the mouth.
To say that a certain technique is a "thing of the past" is a strong statement in a business where every thing can be done at least 10 different acceptable ways.

I don't think any of us would argue that the technique itself is not the best for achieving the intended result. The technique itself is excellent. That is not the issue. What I mean by "a thing of the past" is that now that we know more about the risks we run by sticking our fingers in the mouth of patients with unknown diseases, the stakes have changed, the wager is higher, the bet is more critical. We didn't know that we were gambling our life so much with each infection we got from patients.

Of course you can do it 10 different ways! But if you think you are risking your life and that of your wife or husband, and your children are going to become orphans prematurely, you are a little more careful when choosing one of those 10 different ways.

The same goes for the techniques where the surgeons have to feel the tip of the needle with their fingers: that is suicidal. It should be banned. In the 1960s and 1970s, when we didn't know the full consequences of a needle stick, it might have been acceptable, but now that we know better, it is insane, not because it doesn't achieve the desired results, but because of the risk involved for the operator.

I don't think physicians have to risk their lives to cure someone. Call me selfish, call me whatever you like, I think we should be careful with ourselves, at least as much as we are with our patients. Look at the radiologists: they learned to protect themselves from radiation, and nobody expects them to expose themselves to the X-rays in order to take better X-rays.

Greetings

 

[Planktonmd]

I don't think any of us would argue that the technique itself is not the best for achieving the intended result. The technique itself is excellent. That is not the issue. What I mean by "a thing of the past" is that now that we know more about the risks we run by sticking our fingers in the mouth of patients with unknown diseases, the stakes have changed, the wager is higher, the bet is more critical. We didn't know that we were gambling our life so much with each infection we got from patients.

Of course you can do it 10 different ways! But if you think you are risking your life and that of your wife or husband, and your children are going to become orphans prematurely, you are a little more careful when choosing one of those 10 different ways.

The same goes for the techniques where the surgeons have to feel the tip of the needle with their fingers: that is suicidal. It should be banned. In the 1960s and 1970s, when we didn't know the full consequences of a needle stick, it might have been acceptable, but now that we know better, it is insane, not because it doesn't achieve the desired results, but because of the risk involved for the operator.

I don't think physicians have to risk their lives to cure someone. Call me selfish, call me whatever you like, I think we should be careful with ourselves, at least as much as we are with our patients. Look at the radiologists: they learned to protect themselves from radiation, and nobody expects them to expose themselves to the X-rays in order to take better X-rays.

Greetings

I am not sure why you think placing your gloved fingers between the teeth of an anesthetized and paralyzed patient is so dangerous!
I wouldn't suggest doing it on awake patients though 🙂
I do agree with the rest of your statement concerning the need to protect our health.

 

[Narcotized]

we know more about the risks we run by sticking our fingers in the mouth of patients with unknown diseases, the stakes have changed, the wager is higher, the bet is more critical. We didn't know that we were gambling our life so much with each infection we got from patients.

I share your fear of patient diseases, but I don't think statistics support this fear too much. Oral surgeons spend the entire day sticking their hands in mouthes, and I'm not aware of the risks being significantly common.

 

[Depakote]

could you guys define "proper preoxygenation"?

After reading the advice in this thread, I have been trying to approach my airways in a more calm and deliberate manner, but I've had a couple desat on me after what seem like a minute or two. We'd pre-oxygenated. One was a smoker, the other was obese... Did we not pre-oxygenate them sufficiently for a student intubation? Is it possible to do so in these populations?

 

[igottaquestion]

ps- If you're still having trouble intubating, it's probably Obama's fault.

 

[proman]

could you guys define "proper preoxygenation"?

After reading the advice in this thread, I have been trying to approach my airways in a more calm and deliberate manner, but I've had a couple desat on me after what seem like a minute or two. We'd pre-oxygenated. One was a smoker, the other was obese... Did we not pre-oxygenate them sufficiently for a student intubation? Is it possible to do so in these populations?

A smoker should be able to be apneic for more than a minute or two unless there's significant diffusion defect (like a home oxygen type). I'd do the usual 4 vital capacity breaths. The obese drop like rocks. Depending how obese, it maybe wasn't the best person for you to intubate. Things that increase FRC (preoxygenating with the back up, using some CPAP). If the monitor is able to display end tidal oxygen, I like waiting until it's as high as it'll go. I also like using sux on those patients because chances are they'll desat with the NMBs.

Of course, what felt like a minute to you may have been 4 minutes in real time.

 

[pgg]

Things that increase FRC (preoxygenating with the back up, using some CPAP). If the monitor is able to display end tidal oxygen, I like waiting until it's as high as it'll go.

Agree, position and a bit of CPAP makes a real difference in the obese & pregnant.

Sometimes the hardest part of preoxygenating is ignoring the glares and foot tapping from the OR crew while you stand there doing "nothing" prior to induction.