I forever feel uneasy about intubating. I want to excel but instead hover around adequate. I am not the guy who gets the airway that no one else could.
I’ve read airway texts and been through intubating courses and know lots of tips and tricks to bring the cords into view. It doesn’t seem to matter though, I still feel like I struggle way more often than I should. I get it done, but not with the grace befitting a skilled ER doc.
There’s one last method I haven’t tried. It’s not in any book or course, but I’m convinced it will make me better. So I’ve started lifting.
Yep, I found a ratty bench and set of weights on craigslist for $20 and have trudged out to my garage every other day for the last two weeks powering through a routine more suitable for a girl’s junior high B-team basketball squad. Oh well you have to start somewhere.
Weight-lifting note #1: I mean people it really is shocking how weak I am.
Weight-lifting note #2: Especially my left arm. I played a lot of tennis growing up so my right arm is twice as strong as my left. Which is kind of like saying Harry is twice as smart as Lloyd. Too bad when intubating you have to hold the laryngoscope with the left.
Weight-lifting note #3: Do not lift just before going into work. You may find your hands to be a wee bit shaky when sewing up a lac.
Weight-lifting note #4: I’m not that into music. All I ever listen to is podcasts but I need something a little more upbeat to get through my Curves workout. The only music I have though are some mp3’s I picked out from my sister’s old converted CD collection. It turns out the music I have is pretty mellow — the only thing I have close to upbeat is a No Doubt album. Which means I’ve had Spiderwebs in my head for like two weeks running. ”Sorry I’m not home right now, I’m walking into spiderwebs so leave a message and I’ll call you back!” Kill me.
We’ll see how it goes — the odds are I’ll quit but those dicey intubations provide motivation. Perfect technique will get you far, but sometimes you need to be able to add a little brute force.
And if I get a little cut that’s ok too.
May 7, 2009 at 5:06 pm
Is “I’m Just a Girl” on that album?
May 7, 2009 at 5:44 pm
Ha. Yes it is.
May 7, 2009 at 7:13 pm
This is hilarious.
“Which is kind of like saying Harry is twice as smart as Lloyd.”
“I need something a little more upbeat to get through my Curves workout.”
I mean, how do you come up with this stuff!!!?
May 7, 2009 at 7:31 pm
If you lift enough weights and your neck circumference increases enough, you can be an orthopod and get paid $1000/night to sit on your arse at home and not see any patients. Your dream job?
May 8, 2009 at 11:00 am
I’d have to dumb down to be an orthopod, but that seems to come with the lifting. I also just ordered the Girls Gone Wild anthology for some reason.
May 9, 2009 at 5:58 pm
I’m sure you ordered that because you know that all the young women are on SPRING BREAK!!! from college and want the inside scoop on the up-and-coming whos-who of academia.
After you lift enough weights and do enough of an ortho residency, you’ll also note, just to warn you, there are girls flashing their boobs and kissing each other. Obviously, intelligent ER docs would just fast-forward through all this and skip to the parts where they talk.
May 7, 2009 at 7:47 pm
What about a Glidescope? http://www.verathon.com/glidescope_index.htm
May 8, 2009 at 11:03 am
Tried that but administration said it was too expensive. Let me know if you find a coupon.
May 8, 2009 at 7:34 pm
My husband is a RT, so just do what he did to get the GlideScope–make sure the sales person is a tall leggy blond, call the Administrator around to the ED and have her demonstrate it for him………and we are a very very small rural hospital….and we got ours pronto….and we have a cheap Administrator.
May 8, 2009 at 12:50 am
Switch to L instead of R, I’m just saying it can’t hurt, I’m 10 for 10
May 8, 2009 at 9:25 am
Watched an intubation a couple days ago where the pt. bit down hard on the laryngoscope resulting in a cracking/crunching sound that made my skin crawl. Chipped teeth, you might think? Nope. MD withdrew the blade to reveal that the pt. had crunched the light bulb. Good thing the pt. didn’t make it or else we’d be figuring out how to remove broken glass shards from the mouth and airway… Wait, that came out wrong..
May 8, 2009 at 9:49 am
drag an old tv and a VCR (yes a vcr) and listen/watch some old movies you haven’t watched in a long time. Maybe put in a really bad movie so you will think to yourself, “if i get through this set, i can turn this thing off”
May 8, 2009 at 11:20 am
I put in Maid in Manhattan but ended up losing the will to live. Thanks for the advice though.
May 8, 2009 at 10:34 am
I hope you are not just working one set of muscles in your body but working them all so you don’t end up looking beefy up top and scrawny in the legs!
May 8, 2009 at 12:18 pm
This whole post is making me laugh. I love it!
I have been doing the 30 day shred with Jillian Michaels. Before I tried it, I thought I was in great shape. I run and swim a lot and I figured I was just doing it to do something different. After the first time, my whole body was shaking. I tried to give my kids a bath and could barely lift my arms. I was shocked. My point is that her workout really kicked my butt and now I have all these muscles that I never even knew existed. Maybe that would work for you? I wish I could loan it to you so you could see. You know, since you are into girly workouts and all.
(I am totally just teasing you with the girly workout thing, hopefully it comes across like that when you read it!)
May 8, 2009 at 12:58 pm
Tori, the only thing keeping me from kicking your ass is the fact that I couldn’t
May 8, 2009 at 3:12 pm
Check out fitpod.com. Great free mixes for your Ipod, I can always find one that is the right length and beat for the workout I’m doing.
May 9, 2009 at 1:06 am
Lady Gaga is supposed to be good for workouts.
May 9, 2009 at 9:52 am
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May 9, 2009 at 12:04 pm
Luke Skywalker knew a great deal about ‘the force’ and he had completed the ‘basic “force” training course’, but he was still unable to lift the crashed space ship from the pond. He failed because, on a subconscious level, he didn’t believe that he could do it.
Have anesthesia in the room every time you think that intubation may be required. Knowing that you have back-up will mitigate the pressure, and it will also provide a mechanism for you to get feedback on your technique
May 10, 2009 at 9:17 am
Get a Glidescope my friend….
May 10, 2009 at 2:41 pm
better than being “the guy that gets the airway noone else can” is recognizing when you are in over your head and having a backup plan. i wouldn’t be so hard on yourself.
that said, the bougie has gotten me out of some very sticky situations- if your dept doesn’t have any i would enthusiastically recommend you invest in some (i think they’re pretty cheap)
preparation is the most important part of any procedure!! i learned this over and over in residency. do a good airway assessment before beginning and getting the patient in the “sniffing position” with towel rolls really goes a long way to improve visualization.
to shoot off on a tangent, one of the attendings where i trained once paralyzed someone without assessing their anatomy and they turned out to have their jaws wired shut from recent surgery (!!!)- wound up cutting them with wire cutters to get the tube in!
May 11, 2009 at 4:06 am
In a perfect world, style points would count. Stay thirsty, my friend.
May 13, 2009 at 1:29 pm
I think we need pictures.
May 14, 2009 at 5:56 pm
Better to be good with a Mac blade than rely on a glidescope. My tips:
1. Position. I don’t know if you ever have obese patients. Consider building a ramp under the shoulders. For regular patients, make sure the head is near the end of the bed, and the bed is high enough. Place a small pillow or cushion under the head. Use a shoulder roll for infants.
2. Insert the blade slowly, sweeping the tongue to the left (for the Mac). Watch your view the entire time.
3. I’m nearly finished with anesthesia residency, but still sometimes surprised how much force I have to apply in the direction the tip of the laryngoscope handle is pointed. Sometimes this literally lifts the patient’s head off the bed, creating an exagerrated “sniffing position.” In this setting, sometimes it’s helpful to have an assistant support the head.
Alternatively, maybe you could visit the OR’s and have a friendly anesthesiologist let you assist in controlled, non-emergent airways.
Good luck!
May 14, 2009 at 6:08 pm
Intubating is like sex–positioning is everything. I’m 5 feet tall, weigh just over 100 pounds, and I’ve intubated 300 pounders just by using good technique. I certainly don’t have any muscle mass.
May 16, 2009 at 8:56 pm
intubation scares me lol and i’m not a doctor lol
May 18, 2009 at 1:53 am
I hope that JG is female, or my buzz is ruined.
May 19, 2009 at 1:19 pm
Dumb jock jokes aside, it might amuse you to know an ER doc recently coauthored a weight training book, “Body By Science”. There are a bunch of videos of him speaking on YouTube and he doesn’t sound like his brain has atrophied too much.
June 11, 2009 at 10:14 am
[...] http://trismus1.wordpress.com/2009/05/07/difficult-airway-course/I’ve read airway texts and been through intubating courses and know lots of tips and tricks to bring the cords into view. It doesn’t seem to matter though, I still feel like I struggle way more often than I should. I get it done, … GlideScope–make sure the sales person is a tall leggy blond, call the Administrator around to the ED and have her demonstrate it for him………and we are a very very small rural hospital….and we got ours pronto….and we have a cheap Administrator. … [...]
June 20, 2009 at 11:48 am
[...] http://trismus1.wordpress.com/2009/05/07/difficult-airway-course/Quick scan of the net – pronto airways « Tanai Brown Says: June 11, 2009 at 10:14 am. […] http://trismus1.wordpress.com/2009/05/07/difficult-airway-course/I’ve read airway texts and been through intubating courses and know lots of … [...]