Clinical question about laryngoscopy - page 2
Question for you SRNAs in clinical and practicing anesthetists: How often do you get a Grade I or Grade II view? I have started missing an intubation or two per week (probably because I am... Read More
Jun 14, '04Occupation: AA Specialty: 32 year(s) of experience ; From: US ; Joined: May '04; Posts: 1,134; Likes: 106Quote from sonessrnaYou'll be an expert by the time you're done with school, don't worry. I'd guess I see cords maybe 80% of the time (?), and most of the time if I don't see them, I have enough curve in the tube to "scoop" it in on the first attempt anyway. If I'm pretty sure I can get it in with enough curve, I'll add a stylet on the 2nd try. 3rd attempts now we either go with a lighted stylet or to an LMA. Continued repeated attempts will lead you down a slippery slope, so unless you can't ventilate the patient, I'd pop in an LMA and re-think, or awaken the patient.I'm not an expert in intubations...but I have only had 1 blind intubation since I started intubating and I did an esophageal intubation with that also my only esophageal intubation yet so far.. I think you should always be able to see cords or be using something to augment your intubation...at least that is what we are being taught in school. I have been using a MAC 3..I'm going to attempt the MIller blade this week.
The slickest thing I've seen recently is a device called a GlideScope. It's basically a curved blade with a TV camera at the distal end of the blade. You watch the view on the TV screen, and watch the tube go in. There's no need for a sniffing position, because you're not having to bring all the airway structures into a straight-line view. Get a rep to bring one in for your class to try out if you haven't seen one. You'll be impressed.
Anyone who claims they never get an esophageal intubation, ever, is fudging little to say the least, even an experienced anesthetist. It's not a sin to put the tube in the wrong spot - the sin is in not immediately recognizing it and putting it in the right spot.
Jun 14, '04Occupation: CRNA Joined: Jun '03; Posts: 460; Likes: 3the sin is in not immediately recognizing it and putting it in the right spot.
Jun 15, '04Joined: Apr '04; Posts: 14; Likes: 1How many attempts would you make at an intubation using a MAC or Miller blade before going to other interventions in order to establish a definitive airway? Is there a specific protocol for this or does it generally depend on the one doing the case?
Jun 15, '04Joined: Mar '04; Posts: 144; Likes: 5Is there a specific protocol for this or does it generally depend on the one doing the case?
Patient condition also plays a factor. Preceptors are less indulgent of repeated attempts with sicker, obese, or pediatric patients!