intubation skills

[craigkes]

I have a question for all you seasoned pros out there. I have been on anesthesia for about 1 week during my third year here and I have only been successfull in about 50 percent of my intubations. I am going to be gunning for an anesthesia residency next year and granted they don't ask during the interviews "what's your intubation success rate?" it is still kind of a confidence killer when your only hitting a bit over half of your patients successfully. Granted a couple of my intubations felt like I was trying to tube a rock but those were the exceptions, the majority have been fairly straight forward. Did you guys feel that way when you started? Just curious is all. Thanks for the input.

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[drccw]

don't worry about skills... especially as a medical student... I know a good number of CA-1s who still can't intubate....

Skills will come to you- that is what residency is for....
Hell when I started residency I couldnt start a PIV on anyone.... and for the first two weeks I felt like I was a failure... but that time is long gone. your skills will come- and here is how- always practice... dont be afraid to perform laryngoscopy... any patient that is a potentially difficult airway (not someone who needs an awake fiber obviosuly), I always did one look with a laryngoscope before heading to a FOB. When you are starting- always start a second PIV after a patient is asleep. Practice practice practice...

Though dont take it to an extreme. I had an attending once who told me to slap one of the long 25 G needles and practice hitting the IJ while the patient was asleep... that's one thing I didnt do..

your goal is to position yourself as best as possible for a future in anethesia. Talk to attendings, read, show that you are bright and hardworking and can think most importantly... any monkey can intubate, place lines.. critical thinking is how to separate yourself from the monkeys..

 

[Jeff05]

dude you should be intubating 100% of your patients immediately. there is no learning curve. you're either good at it or you're not. it's an innate skill. once you're an attending there is no such thing as a "difficult airway" you will be able to intubate everyone, on the first try.

not being able to master a key anesthesia skill, which practitioners spend years perfecting, immediately without practice should logically be a confidence killer.

 

[jetproppilot]

I have a question for all you seasoned pros out there. I have been on anesthesia for about 1 week during my third year here and I have only been successfull in about 50 percent of my intubations. I am going to be gunning for an anesthesia residency next year and granted they don't ask during the interviews "what's your intubation success rate?" it is still kind of a confidence killer when your only hitting a bit over half of your patients successfully. Granted a couple of my intubations felt like I was trying to tube a rock but those were the exceptions, the majority have been fairly straight forward. Did you guys feel that way when you started? Just curious is all. Thanks for the input.

Not a big deal, Dude.

We were all in your shoes once.

Even, though I know its hard to believe, Venty.

Good luck.

Keep your head up.

 

[VentdependenT]

Not a big deal, Dude.

We were all in your shoes once.

Even, though I know its hard to believe, Venty.

Good luck.

Keep your head up.

Christ I know man. I can't believe I'm almost finished with my CA-3 year...friggen insane.

Anypoops, don't sweat the intubation stuff man. As long as you don't monkey wrench out any teeth youre golden baby.

 

[fakin' the funk]

I recommend getting a better view by cranking on the scope with your wrist and having a go at the central maxillary incisors.

Sorry, I was in the ED last night

 

[deleted9493]

I remember being pretty riled up about my inability to intubate well during my first week of rotation, too. It doesn't help either to hear other students telling you that they were born with the skill.

Fact of the matter is, your current insecurity will soon be an afterthought. Through talking to different practitioners and getting enough practice, you'll figure out what works for you and will probably, not too long from now, be surprised that it was ever even a concern.

 

[Planktonmd]

Procedures in general can be compared to sex:
Performance anxiety makes it worse.
You don't want to be compared to anyone else.
The more relaxed you are the more successful you will be.

 

[amyl]

OP -- (MS4 here). I know how you feel: I wanted to take to intubation like a duck to water. It'll come, don't worry. the best advice I can give is make sure you get the sniffing position right to get the best view. In the beginning of my rotations I was lost...towards the end I remember the only one I missed, the attending ended up having to fiberoptic (OSA obese type patients ). it'll come. one of my attendings said it takes 100 to not suck at intubating, so be patient.

with practice it becomes cerebellar memory...like tiger woods doesn't have to think about his golf swing and how to hold the club.

 

[craigkes]

Thanks everyone for the input. It sounds a bit insecure but it does help to hear that I am not the only one to have a rough go of it at first. Thanks for all the comments.

 

[SleepIsGood]

Procedures in general can be compared to sex:
Performance anxiety makes it worse.
You don't want to be compared to anyone else.
The more relaxed you are the more successful you will be.

Hilarious!!!

 

[lfesiam]

Hilarious!!!

Agreed.

To the OP. What helped me:

1) Cricoid Pressure to align the airway!
2) Scissor Technique
3) Using my beer belly to help stablize the sniff position...wierd but works for me


I love using the Mac blade, mac 3 or 4 can get me in most cases. Miller on the other hand.....i'm still 50%..sigh.

 

[TheEleventhReel]

Procedures in general can be compared to sex:
Performance anxiety makes it worse.
You don't want to be compared to anyone else.
The more relaxed you are the more successful you will be.

Also, the faster you finish, the more tv you get to watch.

 

[Leverage]

I am just ending my fourth year but what helped me is as others metioined, SNIFFING POSITION. Seemed like if I used my right hand to get pt in the sniffing position while getting scope in position with other hand, everything else fell into place. It took me two days of looking like a jackass before I figured out how helpfull position is.

Seemed like I could get the ETtube in almost everytime with class 1 and 2 mallampati scores just getting the patient in the right position.

The other thing is take your time if you have them good and preventillated. No need to rush you got the time. And if you don't get it not a big deal as long as you can ventalliate.

Along the sex analogy... Praciticing is fun and you don't have to be a pro right away to have fun.

 

[lfesiam]

I am just ending my fourth year but what helped me is as others metioined, SNIFFING POSITION. Seemed like if I used my right hand to get pt in the sniffing position while getting scope in position with other hand, everything else fell into place. It took me two days of looking like a jackass before I figured out how helpfull position is.

Seemed like I could get the ETtube in almost everytime with class 1 and 2 mallampati scores just getting the patient in the right position.

The other thing is take your time if you have them good and preventillated. No need to rush you got the time. And if you don't get it not a big deal as long as you can ventalliate.

Along the sex analogy... Praciticing is fun and you don't have to be a pro right away to have fun.

can't resist to add to the sex analogy, is it just me or the vocal cords look very similar to you know what.

another analogy, i've heard some refer them as the "the anesthesiologist's promise land".

 

[ZA_Gasman]

dude you should be intubating 100% of your patients immediately. there is no learning curve. you're either good at it or you're not. it's an innate skill. once you're an attending there is no such thing as a "difficult airway" you will be able to intubate everyone, on the first try.

not being able to master a key anesthesia skill, which practitioners spend years perfecting, immediately without practice should logically be a confidence killer.

You're pulling the P**s right? Or do I need more sleep?

 

[urge]

Worked with an anesthetist today, who of course uses the Miller blade 100%, having a hard time getting the tube in. Blade was midline being almost wrapped by the tongue. I say "blade is not in the right place". Reply: "I know it looks funky but it works for me" I think "it looks funky because it is, and it ain't working for you" but decided to be patient and wait. After a while of messing around and repeating "blade is not in the right place" I couldn't take it anymore and asked politely to have a look. Grade 1 view intubated in less than 8 seconds. Afterward all I heard were excuses: the cords were like this... yada yada yada....the stylete...bla blah blah. My main concern now is how do you tell people and make them realize they are doing stuff wrong without hurting their ego when they are "professionals". Touchy subject. Any ideas?

 

[jetproppilot]

Worked with an anesthetist today, who of course uses the Miller blade 100%, having a hard time getting the tube in. Blade was midline being almost wrapped by the tongue. I say "blade is not in the right place". Reply: "I know it looks funky but it works for me" I think "it looks funky because it is, and it ain't working for you" but decided to be patient and wait. After a while of messing around and repeating "blade is not in the right place" I couldn't take it anymore and asked politely to have a look. Grade 1 view intubated in less than 8 seconds. Afterward all I heard were excuses: the cords were like this... yada yada yada....the stylete...bla blah blah. My main concern now is how do you tell people and make them realize they are doing stuff wrong without hurting their ego when they are "professionals". Touchy subject. Any ideas?

You can't change people, dude. Dude aint gonna change...for you, or anyone else.

What you CAN do is ask them:

"Are you open to some feedback?"

Then givvem your speal if they say "yes." They either accept it or not. But thats their game, not yours.

Acceptance of this will contribute to your inner peace.

 

[Leverage]

Worked with an anesthetist today, who of course uses the Miller blade 100%, having a hard time getting the tube in. Blade was midline being almost wrapped by the tongue. I say "blade is not in the right place". Reply: "I know it looks funky but it works for me" I think "it looks funky because it is, and it ain't working for you" but decided to be patient and wait. After a while of messing around and repeating "blade is not in the right place" I couldn't take it anymore and asked politely to have a look. Grade 1 view intubated in less than 8 seconds. Afterward all I heard were excuses: the cords were like this... yada yada yada....the stylete...bla blah blah. My main concern now is how do you tell people and make them realize they are doing stuff wrong without hurting their ego when they are "professionals". Touchy subject. Any ideas?

Ego always gets in the way of learning. Too bad the anesthestist dosn't realize it.

Obviously I have never been in the position to teach in the OR, but have been lucky enough to get good teaching. Not just in medical school. But when people really are tied up in their ego I think asking questions that make them evaluate themself are helpful. " So I noticed your technique failed to place the tube, why do you think you couldn't get the tube in? " Then if they give you the excuses... " do you think you would have got the tube in if the blade had been in right place" those type of questions. You know, Dale Carnegie stuff.

I don't think it would be unprofessional had you just told the anesthestist what to do anyhow.

 

[paschal]

Most tennis and golf instructors will tell you to "keep your eye on the ball." When intubating, keep your eye on the vocal cords and watch the ET through them. Miller blades provide tunnel vision, MACs open up the anatomy and provide the "big picture." Use the above suggested maneuvers to provide visualization, persisting until you can see vocal cords. If that is not possible, then use one of the devices which allows you to look around the corner.

 

[jetproppilot]

I have a question for all you seasoned pros out there. I have been on anesthesia for about 1 week during my third year here and I have only been successfull in about 50 percent of my intubations. I am going to be gunning for an anesthesia residency next year and granted they don't ask during the interviews "what's your intubation success rate?" it is still kind of a confidence killer when your only hitting a bit over half of your patients successfully. Granted a couple of my intubations felt like I was trying to tube a rock but those were the exceptions, the majority have been fairly straight forward. Did you guys feel that way when you started? Just curious is all. Thanks for the input.

BTW, Dude, if you are really getting 50% of intubations as a third year med student,

MY JOB IS IN JEAPORDY.