Procedures are rough

[DocDanny]

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I tried my first procedures today. I failed an intubation and went 1-2 on central lines.

These are the most difficult part of my job so far. Anyone else frustrated by them?

 

[danzman]

Like most things in life, the more you do, the easier it gets.

 

[mlw03]

(Most) every specialty has their procedures that residents have to learn. There's really no way to prep for that other than to read so that at least you know the theory and what should be occurring, and then to just keep trying them. I'm a forensic pathologist for example, and detailed neck dissections took me a little while to get comfortable with (an important procedure in strangulation cases). You should also certainly ask those more senior for some guidance as well. But ultimately you just have to keep doing it until you get comfortable with the common procedures expected for your specialty.

 

[Top Gun]

All you can do is keep trying. Keep practicing and you'll master them in time.

 

[blue2000]

I found central lines to be like driving stick -- in the beginning you feel like a total flail but then all of a sudden something clicks and it just feels right and you don't know how you couldn't do it before.

So be safe but keep trying. I've seen junior residents avoid attempting procedures because they feel like failures, and while I understand the impulse you absolutely shouldn't do that. You've got to keep throwing yourself at it til you get it right. And it's at times challenging to admit that you are struggling with something (going 1/2 for a central line at this point isn't struggling, IMO) but you really need to for your patients.

 

[Impromptu]

Pre-read and watch videos. 1st attempt is slow, feeling out what you learned. 2nd attempt is trying to fix all the things you did wrong the 1st time. 3rd attempt and you are feeling pretty good.

If you want to get good at intubations, take an anesthesia rotation and practice them in very controlled settings. Proper positioning will make a huge difference, especially correct ramping.

 

[DocDanny]

2-3, and feeling better.

But oh my GOD it takes forever.

 

[Mattchiavelli]

for me it was always the sweating, I would get nervous then sweat like a pig under the gown/mask.

In my ICu rotation last year I finally got some intubations that worked, however to start out I swear they were only giving me people with horse teeth and necks the size of virginia hams. Central lines are easier/harder based on the patient, howe well they're tolerating, awake or asleep, etc. For some reason a thoracentesis was always the easiest for me and if I would continue doing any medicine procedure it'd be that... now it's all LPs, which are getting easier (and less pink CSF)

 

[gutonc]

for me it was always the sweating, I would get nervous then sweat like a pig under the gown/mask.

In my ICu rotation last year I finally got some intubations that worked, however to start out I swear they were only giving me people with horse teeth and necks the size of virginia hams. Central lines are easier/harder based on the patient, howe well they're tolerating, awake or asleep, etc. For some reason a thoracentesis was always the easiest for me and if I would continue doing any medicine procedure it'd be that... now it's all LPs, which are getting easier (and less pink CSF)

Agree with this. You start sweating because of the mask/gown/lights, then the attending is standing either over your shoulder or at the foot of the bed, making things worse from the sweating perspective.

As others have said, practice makes perfect...or at least, better than you were.

I rarely if ever do any procedures any more (other than bone marrow biopsies) but thoracenteses are far and away my favorite. They're pretty easy to do (especially if you can grab an ultrasound) and they have nearly instantaneous positive (mostly) effects on the patient. It's the rare patient who feels better with a TLC sticking out of their neck or a tube in their throat...almost everybody who needs a thoracentesis feels better when it's done.

 

[nlax30]

If you want to get good at intubations, take an anesthesia rotation and practice them in very controlled settings. Proper positioning will make a huge difference, especially correct ramping.

Certainly agree with that. As a med student I never did an anesthesia rotation and at beginning of intern year I struggled a bit with intubations. Central lines seemed to fall into place but I had a rough start with my first few airways. It didn't help that they were basically crash airways during codes or rapid responses but it still shook me. After a few more controlled intubations in the ICU and then on my anesthesia month things got a LOT better. I just needed a more controlled setting initially to get the movements and technique down.

 

[Rendar5]

Go to Scott Weingart's site for good Central Line and intubation videos. emcrit.org