Intubation Proficiency

Discussion in 'Anesthesiology' started by donkeykong1, Aug 9, 2015.

  1. donkeykong1

    7+ Year Member

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    MS-4 here most likely headed to Anesthesiology. So far I've done about a dozen or so intubations with about a 50-60% success rate. I get to the epiglottis then I start having trouble if the patient's head won't extend back far enough to get a better view of the cords or if they're just really obese or if they have super fragile teeth.

    About what point in training do Gas residents develop proficiency in airway management. Given that most intern years maybe just have 1 month of Anesthesia, what's the starting point for CA-1's then? When do residents start their own cases or cover the airway team solo?
     
  2. Urzuz

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    You'll feel a lot more comfortable handling an airway by the end of your CA-1 year. Proficiency will continue to develop well into one's first few years as an attending unless they decide they are airway experts after their first 3 months of CA-1 year, at which point learning will plateau.

    I'm sure airway coverage differs from residency to residency. I have heard of CA-1's holding the airway pager in some program; in my program we started sometime during our CA-2 year. Regardless of when it is for your specific program, always know how to call for backup if and when you need it.
     
  3. POW16

    Physician 7+ Year Member

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    New CA-1 here. On call, we go to all the emergency airways on the floor with the senior and we get first crack. We start our own cases July 1st (obviously with the attending there) and even after the first month, the attending is always there at the beginning for induction/establishing an airway.

    As the previous poster mentioned, the answer to your question is very program specific.

    Sent from my SAMSUNG-SM-G920A using Tapatalk
     
  4. donkeykong1

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    How confident were you with airways in July vs now in August?
     
  5. Noyac

    Noyac ASA Member
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    My take on airways is this. It is the one skill you have that is far superior than anyone else in the hospital. This superiority doesn't come quickly or easily for most. It is our understanding of the issues, anatomy, pathology, etc that makes us the go to people in this arena. You can't expect this skill to be honed in a few months. For most, it isn't even honed until a few years out of residency.

    Disclaimer; I have seen some pretty slick pulmonologist/CCM and ENT's with the FOB.

    One of the best comments I have heard in a long while came from one of our surgeons the other day when describing how it was to work with a colleague of mine that has since left. The surgeon said, " well after telling me how difficult the airway was going to be, he sent the hour proving it to me." I just love that!
     
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    #6 Infexious, Aug 9, 2015
    Last edited by a moderator: Jan 20, 2017
  7. Docuronium

    Docuronium ASA Member
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    It will take a long time. The resident (let alone the CA-1) who is 100% confident in their airway skills hasn't run into enough difficult airways.
     
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  8. SaltyDog

    SaltyDog Because my last Avatar was Deemed Inappropriate
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    I'd say it takes at least 80-100 tubes before you can say "that was a tough airway" and have it be because it was actually a difficult airway and not because you still suck.
     
  9. nimbus

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    I would say 500-1000 depending on the person.
     
  10. pjl

    pjl ASA Member
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    I would say it is a changing % that is difficult based on experience.
    First day 75% are "hard"
    First week 50% are "hard"
    First month 25% are "hard"
    First year <10% are "hard"
    First decade <1% are "hard"

    I trust others saying an airway is difficult when they are out in practice after residency. I listen when an advanced resident says it. I kinda blow it off if it is a CA1, especially early.
     

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