Severe Halitosis

[Adcadet]

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So, this week I found something that I didn't think would be a problem - sever halitosis. The patient apologized for not brushing her teeth "today", but I doubt she had brushed her teeth this Month. Since I'm new with intubations I get my head pretty close to the mouth so I can easily see. Luckily the first attempt was successful, otherwise I would have preoxygenated BOTH of us and held my breath for the second attempt.

Any tips for dealing with bad halitosis from some of the pros? Do you just intubate with your arms fully outstreathed? Just leave it to the CRNA/resident/student? Or just suck it up (bad pun, sorry). And yes, this is a serious question since I suspect I'll be dealing with a fair number of patients with less than optimal mouth hygiene.

 

[jetproppilot]

So, this week I found something that I didn't think would be a problem - sever halitosis. The patient apologized for not brushing her teeth "today", but I doubt she had brushed her teeth this Month. Since I'm new with intubations I get my head pretty close to the mouth so I can easily see. Luckily the first attempt was successful, otherwise I would have preoxygenated BOTH of us and held my breath for the second attempt.

Any tips for dealing with bad halitosis from some of the pros? Do you just intubate with your arms fully outstreathed? Just leave it to the CRNA/resident/student? Or just suck it up (bad pun, sorry). And yes, this is a serious question since I suspect I'll be dealing with a fair number of patients with less than optimal mouth hygiene.

If you're smelling the patients breath, you're WAY to close. Learn how to intubate standing as straight as possible, and you'll look like an expert, and eventually you'll catch on.
Makes me cringe when I see someone intubating with their face 6 inches from the patient's. Thats the way my mom would intubate.
Stand tall!

 

[Adcadet]

If you're smelling the patients breath, you're WAY to close. Learn how to intubate standing as straight as possible, and you'll look like an expert, and eventually you'll catch on.
Makes me cringe when I see someone intubating with their face 6 inches from the patient's. Thats the way my mom would intubate.
Stand tall!

I think everyone I've seen intubate bends over and gets their eyeballs within 12 inches of the teeeth. I like to get close so I can see epiglotis and cords well. I guess for now I'd prefer to look like a dork and be a little more confortable. And hey, I'm all ready pretty good at looking dorky - big safety glasses, nice blue gloves on, extra gloves hanging out of my back pocket, "IM dog collar" around my neck, tape, drug cheat sheet and OR schedule in my pocketin my front pocket, PDA in a large case on my hip....just wondering if I can stuff an ambu-bag somewhere. At the rate at which I'm accumulating stuff, I'll be ready to do a whole case in an elevator.

But I'll try working on standing straighter. Maybe that's why I've had minor back pain the last few days. And if you're mom intubates like that, it can't be all that bad 😀

 

[pmichaelmd]

Agree with the above...you don't want to stand that close to the pt. while intubating. Wait until you get your first full stomach case with inadequate cricoid...you'll be wearing his/her breakfast with your mask. You should still be able to adequately visualize the cords from an arm's length away.

Cheers,
PMMD

I think everyone I've seen intubate bends over and gets their eyeballs within 12 inches of the teeeth. I like to get close so I can see epiglotis and cords well. I guess for now I'd prefer to look like a dork and be a little more confortable. And hey, I'm all ready pretty good at looking dorky - big safety glasses, nice blue gloves on, extra gloves hanging out of my back pocket, "IM dog collar" around my neck, tape, drug cheat sheet and OR schedule in my pocketin my front pocket, PDA in a large case on my hip....just wondering if I can stuff an ambu-bag somewhere. At the rate at which I'm accumulating stuff, I'll be ready to do a whole case in an elevator.

But I'll try working on standing straighter. Maybe that's why I've had minor back pain the last few days. And if you're mom intubates like that, it can't be all that bad 😀

 

[Noyac]

Chief year. I was going to start a case of an old as dirt guy with a spinal cord tumor that the neurosurgery resident couldn't wait to decompress. This guy was so sick that he could barely talk. We decided to procede after the IM workup (I don't remember the particulars) and brought the guy to the OR. My attending was going to hold cricoid ( this was one of the attendings that actually did some anesthesia) as I induced RSI. He had a NGtube for a bowel obstruction that the neurosurgeon said was due to his spinal cord tumor. Well I RSI the old guy and as soon as I put the blade in his mouth he starts the vomit foul stool in volumes you wouldn't believe. I suck it clear and tube him. The next day I get called to employee health cause the guy is TB positive and the cultures of the emesis is the source. Cultures were sent for aspiration protocol. All I gt to say is, thank god my arms are long and my site is good, cause if my face would have been as close as so many people that I see intubating I would be TB positive. Oh, the old guy died but not from aspiration or respiratory complications.

 

[Adcadet]

If you're smelling the patients breath, you're WAY to close. Learn how to intubate standing as straight as possible, and you'll look like an expert, and eventually you'll catch on.
Makes me cringe when I see someone intubating with their face 6 inches from the patient's. Thats the way my mom would intubate.
Stand tall!

Earlier this week I had an attending who obviously loved to teach and was tired of seeing The Hunch Back of Medical School trying to intubate, a resident who understood where I was at in my learning (good with a miller, bad with a mac), and we went to town on a case. After fumbling around with the mac and wishing I had the miller on while being badgered into standing straight, I suddently saw a bright light, harps playing, and I could feel God's presence. No, I didn't inject myself with some fentanyl, the cords fell into view beautifully. Next case, less fumbling, more standing straight, same heavenly feeling as the cords were just there. Next case, no fumbling, standing straight, beautiful cords. And each time, the only halitosis I smelled was my own.

Too bad my rotation ended today 😡

 

[Beck928]

Chief year. I was going to start a case of an old as dirt guy with a spinal cord tumor that the neurosurgery resident couldn't wait to decompress. This guy was so sick that he could barely talk. We decided to procede after the IM workup (I don't remember the particulars) and brought the guy to the OR. My attending was going to hold cricoid ( this was one of the attendings that actually did some anesthesia) as I induced RSI. He had a NGtube for a bowel obstruction that the neurosurgeon said was due to his spinal cord tumor. Well I RSI the old guy and as soon as I put the blade in his mouth he starts the vomit foul stool in volumes you wouldn't believe. I suck it clear and tube him. The next day I get called to employee health cause the guy is TB positive and the cultures of the emesis is the source. Cultures were sent for aspiration protocol. All I gt to say is, thank god my arms are long and my site is good, cause if my face would have been as close as so many people that I see intubating I would be TB positive. Oh, the old guy died but not from aspiration or respiratory complications.

YUMMY!