love everything about anesthesiology but there's one problem..

[14970]

i'm having trouble with intubation. when i watch the crnas and anesthesiologists work with the laryngoscope, it looks so effortless and believable that with enough practice, anyone can perform a successful intubation on most patients. it seems simple but every time i attempt another intubation, it seems to get more and more difficult. has anyone felt the same way when they first learned how to intubate?

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[DrDre']

Think positive. It shouldn't prevent you from doing what you love.

It just takes time and practice.

 

[14970]

thanks for the positive advice! i think i'll try my best to learn as much as possible during this rotation. i'm still a 3rd year so i think i'll have plenty of practice during elective rotations.

 

[thegasman]

Don't worry about it, have somebody go through the anatomy af where the laryngoscope is placed and what you should see. The technique just comes with practice, and that is all you need once you get the hang of it.

 

[14970]

thanks guys for the support! i think i understand the anatomy well, my problem is how to lift the blade effectively so that i can see everything well without damaging any teeth. my attending is cool about it and says that everything will come with practice and a few sets of one-handed pushups can really help my strength!

 

[jwk]

The first 1,000 are the toughest. Then it gets easier.

Hey, really, it's all practice. And don't let anyone ever tell you they never miss. If they never miss, they don't do it often enough. It's kind of like what they say about appendectomies. If you've never taken out a normal appendix, you just haven't done enough of them.

 

[Molly Maquire]

The first time I tried it, I couldn't get the tongue out of the way. It was flopping all over the place. I'm worried about this too, because I never really got the hang of it.

 

[sones]

The first 1,000 are the toughest. Then it gets easier.

Hey, really, it's all practice. And don't let anyone ever tell you they never miss. If they never miss, they don't do it often enough. It's kind of like what they say about appendectomies. If you've never taken out a normal appendix, you just haven't done enough of them.

You're absolutely right, it s technique....practice...practice...practice and don't give up.

 

[Skrubz]

Hey, really, it's all practice. And don't let anyone ever tell you they never miss. If they never miss, they don't do it often enough. It's kind of like what they say about appendectomies. If you've never taken out a normal appendix, you just haven't done enough of them.

I've heard the same thing about knocking out teeth during intubation...

Intubation isn't that easy when you're new to it and everyone's watching you, expecting you to do it right. Don't worry, you'll have all of residency to become a pro.

 

[emtdoc2000]

I got my first on my first try, and all but 2 out of thousands over a whole career. ?Reason -- ?mixed hand dominance [Better to be lucky than smart!]? -- and definitely No Fear.

But I know you don't want to hear that.

I think the clumsiness lies in anxiety-driven inhibition. Third year, med school: all the invasive procedures were taught by rsidents who were themselves so anxious about doing that stuff that it was contagious, and led to repeated failures, repeated sticks, persistent guilt about inflicting needless pain. Then I hit my Neuro clerkship, and the Chief Res showed me in the calmest, most laid back manner, how to do a smooth, non-traumatic LP. It was not in the technique; it was all in the attitude.

That's how I taught my own residents.

So: find the coolest, most laid-back, most patient attending or senior res, and rotate into his/her room, let him show you, then guide you. [You'll be amazed before you are half-way through!]

No Fear.

 

[gaslady]

It is all about practice. However, no patient will die because you can't intubate them. They will die if you can't ventilate them. Ventilating is much more important and I think harder than intubating. I struggled when I first learned how to intubate and am still no pro, however I don't approach it with anxiety. I'm much more concerned about being able to get gas in and out. It became easier once I got advice from a few people about how to sweep the tongue out of the way and how to pass the tube. It's one of those things that you will just eventually get once you do enough. Then, you won't even remember what the problem was. Don't sweat it, it will come.

I used to find it really nasty when patients had a lot of airway secretions and they had to be suctioned (especially ventilated patients in the ICU). For some reason I found airway secretions the nastiest of bodily fluids. I was worried about doing anesthesia because I knew that I would have to suction people all the time. Once I got to the OR I never even though about my previous squeamishness because it was just something I had to do to take care of the patient.

 

[joshmir]

yo

which blade have you been using? i used the miller b/c i heard it was the better one to learn with, but was having mad problems. switched to the mac blade, and am now 10 for 10. the mac lets you see structures better, and after you are visibly familiar with the anatomy, it gets much easier.

"now, I'm the MAC."

(he said)

 

[aphistis]

thanks guys for the support! i think i understand the anatomy well, my problem is how to lift the blade effectively so that i can see everything well without damaging any teeth. my attending is cool about it and says that everything will come with practice and a few sets of one-handed pushups can really help my strength!

Don't worry about the teeth, that's what we're here for.

 

[14970]

Haha, thanks for the support everyone. For one of the patients, she was having her wisdom teeth pulled out and during the intubation, I was so nervous because she was so young and her teeth were so beautiful. Imagine waking up and discovering that your front teeth got knocked out by an inexperienced 3rd year student when you simply wanted to remove your wisdom teeth. I would be really mad!