How long before you finally "got it?"

[nvshelat]

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Failing at intubating is a sh*tty feeling. I just finished my first year of MS and am doing a summer program in anesthesia and holy crap I love it. But I tried to intube today and of course, I was in the stomach. I was so sure I was in too, damn!
Is there anything I can do besides practice? I guess the obvious is to review the appropriate anatomy - any good websites better than the anatomy textbooks?
Man I feel like a failure.. I mean, I know I shouldn't be too hard on myself since I only just finished 1st yr; but how long was it until you guys got the hang of this intubation thing? I think my problem was not using enough force.. all I could hear was my heart pounding haha 😳

 

[rmh149]

Failing at intubating is a sh*tty feeling. I just finished my first year of MS and am doing a summer program in anesthesia and holy crap I love it. But I tried to intube today and of course, I was in the stomach. I was so sure I was in too, damn!
Is there anything I can do besides practice? I guess the obvious is to review the appropriate anatomy - any good websites better than the anatomy textbooks?
Man I feel like a failure.. I mean, I know I shouldn't be too hard on myself since I only just finished 1st yr; but how long was it until you guys got the hang of this intubation thing? I think my problem was not using enough force.. all I could hear was my heart pounding haha 😳

Nope, its not the amount of force. One of my many mentors told me "the induction and intubation should be more like a seduction, not a rape".

Your right...dont be too hard on yourself. It was your first time...and as a 1st year MS. With your heart pounding, everyone looking at you, the anesthesiologist who was right over your shoulder...and the patients pulse ox beeping in the background....I am sure you were freaking out. Thats part of the learning process. It was nice of them to let you try...Dont worry, You will get it....and the more you do the better you will get.

Good luck to you.

 

[Noyac]

Try this:

http://forums.studentdoctor.net/showthread.php?t=186136&highlight=intubation

And:

http://forums.studentdoctor.net/showthread.php?t=307685

 

[The_Sensei]

Try this:

http://forums.studentdoctor.net/showthread.php?t=186136&highlight=intubation

And:

http://forums.studentdoctor.net/showthread.php?t=307685

Yeah....and I noticed that you said you were an MSI so MOST IMPORTANTLY, TRY THIS:


Chillin' out.............

 

[Planktonmd]

Yeah....and I noticed that you said you were an MSI so MOST IMPORTANTLY, TRY THIS:


Chillin' out.............

I didn't know they allowed MS1 to intubate people!

 

[granolabar2]

Don't Worry!!! For most procedures (intubations, IVs, ABGs) it is completely normal/typical to not get the first few . . .or for tough procedures, the first 4-5 or more. The key is to step aside after trying once, and let someone more experienced step in. Don't get discouraged, and keep trying in appropriate situations.

Have you read Atwl Gawande's "Complications"? He talks about the difficulty of learning procedures and the importance of not getting discouraged.

Even very senior/respected anesthesiologists sometimes are just unable to do a procedure in certain patients. Not always succeeding (and asking for help, or trying a completely different approach) is part of medicine (although maybe even more so in anesthesia than in other fields).

 

[CremeSickle]

The key to being good at skills is practice.

The key to being a successful intubator is planning for WHEN you miss a tube. It happens is cycles. Sometimes i have difficulty i never expected and sometimes i get tubes other didnt. No rhyme or reason. I believe this to be true of all skills.

 

[nvshelat]

Thanks for the advice guys; also, sorry for not checkin out the FAQ on this topic, just noticed it in there.

The resident and attending were watching me like a hawk the whole time. After I failed the 1st time, resident took over.

Guess I was more bummed out cuz I was having a rough morning all around and I let this be the thing that got to me the most. I'm a little more encouraged after reading some other posts, esp in the clinical rotations forum. I just wish I knew something so I could actually be useful instead of just being in the way

 

[stanleykristian]

So you missed, big deal. Almost everyone will miss the first few. Just remember next time you have a lot more time then you think. So deep breath and relax and then just do it.

 

[Breezee]

I found myself rushing when I was a med student when it came to intubating because I thought I had to get the ETT in as soon as the patient stopped breathing spontaneously. An attending made me go stand against the wall while the patient was on the OR table unconscious, and that pt must have sat there for about 2-3 whole minutes easy without desaturating. This is not the case for everyone, but as long as you adequately preoxygented the pt., you have plenty of time to take your time intubating (in most pts. anyway).

 

[jwk]

The key to being a successful intubator is planning for WHEN you miss a tube.....

And perhaps more importantly, knowing or realizing that you missed. 😉

 

[urgewrx]

I missed my first 10. After that, I haven't missed many.
​

 

[Lonestar]

i am a ca2 and i am still missing some intubations. the key thing about intubations is not the fact that you can't intubate, but CAN YOU VENTILATE THE PT.

 

[Breezee]

I missed a nasotracheal intubation today. Big deal. You recognize that you are not in, ventilate a bit, then try again. Can't let missing a tube defeat you. Get it the 2nd go round.

 

[nvshelat]

Got it!

My first one, I'm officially 1/6

There was a 3D animation floating around here somewhere that I found pretty helpful, it was on youtube, def helped with visualization.

 

[rmh149]

Got it!

My first one, I'm officially 1/6

There was a 3D animation floating around here somewhere that I found pretty helpful, it was on youtube, def helped with visualization.

Congrats! It was a good feeling wasnt it?

 

[rugtrousers]

I'm in that painful first few weeks of my CA-1 year (painful because after you've mastered internship you realize that you're a dolt all over again). Just to put things in perspective, I've had multiple attendings tell me not to worry about mastering procedures, because everyone does eventually. What you should worry about is developing your understanding of anesthesia and what to do when things don't go according to plan.

In other words, relax, you'll get it.

 

[Stimulate]

I didn't know they allowed MS1 to intubate people!

apparently all you need is an R.N. degree now...

Some hospitals even let respiratory therapists intubate.

It took me about 50 intubations to feel like I had a good handle on the technique for non-difficult airway patients. Once you have the technique down then you need to worry about patient factors and plan accordingly(morbidly obese, etc.).

 

[Coastie]

An attending told me that until you do about 700 or so, you shouldn't feel bad about missing them. He is pretty famous for airway, and has stuff in the OR named after him, so I'd trust his advice!

 

[stanleykristian]

Or be an EMT, the skill is one that anyone can be taught. It is all the stuff that comes after that it really hard. Nonetheless congratulations once you think your way past one you can think your way past nearly all.

 

[leaverus]

apparently all you need is an R.N. degree now...

Some hospitals even let respiratory therapists intubate.

In Illinois, RNs are not allowed to intubate (unless they are CRNA/SRNA, of course). EMT-P can intubate in the field; but EMT-B cannot. Not sure about RTs