Intubating

[lastminute2018]

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[bashwell]

When did you all really learn to intubate well? I'm a 4th year student going into anesthesia but I'm still struggling with intubating. Probably only successful 1/3 of the time or less so far. I love anesthesia but I'm wondering if there's ever a time I'll actually get to get better at this skill before its too late

I'm not an attending, but I really doubt you have to worry as a med student. I think you're going to have more than enough practice intubating in residency.

 

[deleted162650]

It takes at least 80-100 to get to the point where you can at least tell if it's difficult because the patient is difficult or if it's difficult because you suck at it.

 

[Aether2000]

Eventually your left arm will become so strong, ypu will be able to levitate the patient's entire body off the OR table and visualization issues will wane..... ;-) Just takes time and experience. Also with todays fiberoptic video-train intubating larygoscopes, many reach for these earlier rather than repeatedly traumatizing the airway and dentition, and the patient experiencing hypertension and tachycardia.

 

[Reveler]

As a 4th year med student with ~80 intubations under my belt, it wasn't until around 40 when I really started to get the hang of fine tuning my hand movements to achieve a better view. The more you practice, the more comfortable you will get. No one expects a medical student to be adept at airway management. Just keep on keepin' on.

 

[Ezekiel2517]

Why do you think you need to learn to intubate as a student? That's what residency is for. Everyone has a different learning curve. Some people may pick things up more quickly in the beginning, but the people with the right attitude, grit, and work ethic eventually blow right by them.

 

[Lecithin5]

You'll be fine, I promise! I was also batting 33% or so as a med student. You'll be proficient very soon into your CA years

 

[T-burglar]

I wasn't nasty until I was about to graduate and in my opinion many of my peers graduated without ever pissing excellence with a laryngoscope

 

[Pharmado]

A resident will graduate with more intubations than they could possibly care to admit. Your ability as a medical student means nothing. Do you enjoy anesthesia, not the mechanical aspects like intubation but the intellectual aspects? Can you see yourself living the lifestyle of an anesthesiologist (long hours, little recognition but truly carrying the pts life/safety in your hands)? Those are the things you need to know. The skills will come, the interest and desire have to be there.

 

[Reveler]

A resident will graduate with more intubations than they could possibly care to admit. Your ability as a medical student means nothing. Do you enjoy anesthesia, not the mechanical aspects like intubation but the intellectual aspects? Can you see yourself living the lifestyle of an anesthesiologist (long hours, little recognition but truly carrying the pts life/safety in your hands)? Those are the things you need to know. The skills will come, the interest and desire have to be there.

Great point. On my last rotation, one of the attendings asked me what my goals for the month were. He let me fumble through an answer and then said, "you're here to figure out if you want to pursue a career in anesthesia. If you're interested and have the aptitude then the rest will fall into place."

 

[deleted547339]

Agree with above. I'm EM->CCM (note: not trying to start a flame war like the previous thread). I probably did 50ish in med school, somewhere between 200-350 in residency and probably 50-100 as a fellow. Everyone has different plateaus in education, but you will get to the point that you can 1) get a pristine airway somewhat reliably 2) get most fairly normal airways and learn how to tweak your technique a bit when it's not perfectly pristine 3) be adept at modifying your technique to get all but the most challenging airways and 4) get all "getable" airways. I feel like my personal progression was somewhere around 1) 50 2) 100 3) 300 4) not there yet.

I suspect my progression was fairly typical. I don't think I'm particularly talented with my hands, but I do have good spacial understanding and have had some great teachers. I also was lucky in that I got a lot of airway exposure in med school, had an high volume anesthesia rotation early in residency and went to a very high acuity program with a lot of airway experience. I'm nowhere near the 1000s of tubes anesthesiologist do in residency, but I feel pretty comfortable.