i do both....doesnt hurt. for whatever reason if you cant get a view with the Gscope, in my opinion one doesnt want to come out and 'reposition', lift the patient (heavy) and then try shoving blankets under him/her.In residency I used blankets, but since the advent of the Glidescope, I've never had to ramp anyone yet.
Where I trained we had the Troop pillow. I loved it. But I still occasionally supplemented the Troop pillow with sheets/blankets to get my ideal position.i've seen this done differently by different attendings...what's your intubating ramp technique for intubating the fatties?
Certainly true and I also frequently did the same in residency, however I offer that perhaps if you go private, you may begin to pare down certain prep or other activities which you no longer find necessary (as remarked by many other private folks in this thread) and may increase your overall efficiency. You may find you intubate obese patients just fine without ramping or perform other procedures without other prep. You'll figure what's worth your time and what's not and still deliver a safe and effective anesthetic. Unlike a colleague in a well known Minnesota "Clinic," who probably doesn't have to turn over their own rooms, setup "stuff" and has people to give them coffee, bathroom and lunch breaks, you may find in private those extra saved minutes allow you to choke down a hurried lunch or take a piss. Since he's teaching residents and has someone available to prep the room, it "saves" him time in optimizing intubating conditions, rather than having the resident struggle.i do both....doesn't hurt.
I do it from the get go.
I believe SleepIsGood refers to the following http://www.skymall.com/shopping/detail.htm?pid=96981577&c=http://media.gatewaync.com/wsj/images/2009/08/28/sleep.jpg
This isnt it, but theres something that looks like these 'troop pillows' that you see on those "SKY MALL" mags. Apparently you can open it up and place it on tray tables and use it to sleep on.
Those troop things i be are real cheap blankets man, blankets.
This made me think of one of my buddies who finished last year and is now in PP. He sticks the subclavian from the head of the bed because he says it takes too long to walk around to the side.Certainly true and I also frequently did the same in residency, however I offer that perhaps if you go private, you may begin to pare down certain prep or other activities which you no longer find necessary
Right? Where does it say you gotta do a subclavian from the side? I say, more power if he can do it from the head of the bed - totally saves you from walking around the anesthesia machine and back... Now if I can figure how to do the radial A-line from the head of the bed... Prior to my current place of employment, you'd have to start the peds IV and mask as well, so they'd just pull the kid's hand over his head to you and you'd mask w/ left hand, and stick w/ right hand - thank goodness they'd connect up the IV at least. Now that I think about it, I could totally do it - I'd just have the patient's hand taped up by his head in position w/ the armrest going upwards (sorta like they were holding their right hand up swearing in a court of law). I'm gonna try it on my next cardiac case... induce/intubate, then A-line at head of bed, then central line - will save me from walking back and forth. Nice...This made me think of one of my buddies who finished last year and is now in PP. He sticks the subclavian from the head of the bed because he says it takes too long to walk around to the side.
Hello,I don't use the ramp and I haven't used a miller blade in years with the exception of peds.
How young do your peds cases go to? I haven't found an adequate substitute for a Mil 0 or 1 or WhisHipple 1.5 in a MAC blade. I'm a little skeptical that you intubate anybody under the age of 18mo's - no offense.Why on earth would you use a Miller blade for peds? I have done thousands of peds
Well on the kiddo's a MAC is fine but on the little tikes I use a mil. I use the biggest miller I can safely get in their mouth also. And I use it like a MAC (in the vallecula) first and if I can't see anything good then I move to the classic miller approach (lift the epiglottis). This is just how I was trained.Hello,
Why on earth would you use a Miller blade for peds? I don't use the Miller blade for anything. In 35 years I never had a case where the Miller blade made things any easier, whether peds or adults. But of course, I have colleagues that swear for the Miller and never use a Mac. I guess it is a matter of habit. I have done thousands of peds, and I always had a full set of Miller blades, all sizes, in case I needed to use them. Many times I decided to start using the Miller and used it exclusively for several weeks at a time, but always came back to the Mac.
Regarding ramping, I never ramp anyone either. I see my colleagues ramping their patients and having to climb on several footsteps in order to reach the patient. I find it ridiculous. Maybe I am too old-fashioned or too unteachable. If I need to align the axes, I just pull the laryngoscope up and lift the head off the table, or lower the headpiece to hyperextend the head, because sometimes the alignment is achieved by flexing the head and sometimes by extending it, and not always it can be predicted which one will be more effective. I prefer to have the possibility to do both. If you ramp the patient, when you want to flex or extend the head, it becomes a major enterprise.
Hello,How young do your peds cases go to? I haven't found an adequate substitute for a Mil 0 or 1 or WhisHipple 1.5 in a MAC blade. I'm a little skeptical that you intubate anybody under the age of 18mo's - no offense.
HAHAHAHAHAHAHAHAHAHAHAHAHAI don't do any of this crap. I'm pretty sure the ramps are useless. THe most I do is rev tberg.
Hence my fight against The Establishment.I think back to all the stupid things my attendings made me do for no reason at all... Like the attending who refused to let me do my ultrasound-guided nerve block with my other hand because I wasn't technically ambidextrous... What?!?! I can't guide a needle w/ my non-dominant hand because the positioning is better for this particular case? Crazy...