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Did you get your first intubation?

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by louloubell1 louloubell1 (Member)

Specializes in Anesthesia.

Did you get your first three? I'm 0 for 3 now, and getting frustrated. The first time, I couldn't get a view of anything. I felt better about that one though after the CRNA I was with said that the patient's airway was odd (it was deviated far to the left), and he had a little trouble visualizing the cords too. That's the only one though that I can rationalize by weird anatomy. I've missed two others since then. *Sigh*. I've practiced in lab with the mannequins and such, but it is so different when you're doing it on a live person. Everyone in the OR is staring at you, you're trying to relax and take your time, and suddenly "DING, DING, DING..." - your alarms are going off, and you're thinking "OMG, I have to get this tube in you!" It's just frustrating, and I think I'm the only person in my class to have missed all their attempts so far.

Don't worry about it - it's a skill that takes practice, like anything else. I remember being so focused on staying off the teeth that I would find it difficult to concentrate on anything else. The first intubation I got was on a person with no teeth:-) It will come...what blade are you using?

Did you get your first three? I'm 0 for 3 now, and getting frustrated. The first time, I couldn't get a view of anything. I felt better about that one though after the CRNA I was with said that the patient's airway was odd (it was deviated far to the left), and he had a little trouble visualizing the cords too. That's the only one though that I can rationalize by weird anatomy. I've missed two others since then. *Sigh*. I've practiced in lab with the mannequins and such, but it is so different when you're doing it on a live person. Everyone in the OR is staring at you, you're trying to relax and take your time, and suddenly "DING, DING, DING..." - your alarms are going off, and you're thinking "OMG, I have to get this tube in you!" It's just frustrating, and I think I'm the only person in my class to have missed all their attempts so far.

louloubell1

Specializes in Anesthesia.

Don't worry about it - it's a skill that takes practice, like anything else. I remember being so focused on staying off the teeth that I would find it difficult to concentrate on anything else. The first intubation I got was on a person with no teeth:-) It will come...what blade are you using?

All three times I've tried with a Mac. It was suggested to me that learning with a Mac would be easier than starting off with the Miller. What do you think? I appreciate your encouragement. I think, like you mentioned, that part of my problem is that I'm worried about chipping teeth or causing some type of soft tissue injury, so I'm too tenuous with the blade.

Lou

I missed my first three using a MAC blade, I just couldn't lift well, plus I hated that whole scissor opening of the mouth thing. I felt like the MAC tool up a lot of room. I tried with a miller 2 and bam, it was amazing that I could see the cords. I haven't had a problem using the miller yet, I've even switched to the mac occasionally to ge tused to using it. Don't worry about missing, it is a skill, and I felt like a total loser for missing my first three. The first one I did get the MDA actually put a teeth guard in so I wouldn't worry about it! If you're really worried about the teeth you could put an alcohol swab unopened on the upper teeth but it's probably better to learn not to lean on the teeth at all.

I missed my first three using a MAC blade, I just couldn't lift well, plus I hated that whole scissor opening of the mouth thing. I felt like the MAC tool up a lot of room. I tried with a miller 2 and bam, it was amazing that I could see the cords. I haven't had a problem using the miller yet

Me too. Hate, hate, hate, putting my hands in someones mouth so I don't ever(except with the LMA)

I use my right hand to tilt the head into sniff position and then take my right hand and pull down on the chin. Slide my Miller into the R of center and gently sweep slightly to the L. Go slow and identify the structures and use your R hand to move the trach from side to side if you can't see.

I too felt the Mac is too big for some people's mouth. But, I can use it if I have to.

Good luck, it does take some time to develop the skill. You'll be fine.

skipaway

Not that I am an expert but, here is what worked for me. First, slow down. Take the time to check the teeth, make sure you aren't cutting up their lips. I use a Mac 3 for women and 4 for men, generally. Miller is alittle tougher and requires more perfect placement. I used to jockey their heads around until I got yelled at for it. That is when I started to get the blade into the valecula, and just lift towards the opposite wall to ceiling joint. Some of the Docs won't allow you to touch the patient's head to reposition. When you lift with the blade, their head assumes perfect sniffing position, and viola, the cords usually come into full view.

Take the time to make some adjustments. Take note of what tends to work for you. I always thought that the head extended position was the logical way to position the head. When you assume the chin in the air position, you are actually occluding your view. Sniffing position is the only way to go. Either put them in it before you scope, or start using the lifting of the head technique.

To answer your question, I think I missed my first 4 or 5. Haven't missed one in 10 months though, so I am probably due :)

louloubell1

Specializes in Anesthesia.

Thanks to everyone for your replies. It's been encouraging for me to read them.

Lou

I have only been using the miller. I am waiting to try the mac after I feel I am proficient with the miller. I have gotten my intubations easily & then there are days I couldn't get one no matter what. The two biggest pieces of advice that have helped me (other than the lift forward & up!!) are #1)Go into the mouth with a focus on the tonsilar pilar then as you get there sweep your tongue over bringing your blade toward the left. This gets you in the right spot in most people to at least see the epiglottis. #2)Once you see the epiglottis & lift it up (if using a miller) get your hand up there on the patients trachea & move it around for yourself. This has been the single most successful tip for me. Usually I find the chords very easily. The thing is getting over the idea that your right hand has to hold the mouth open or tilt the head.

Just an idea of what has helped me-maybe it will help you!!

good luck & don't get frustrated--we all have those days!!:coollook:

PS--I wish I had a dollar for everytime someone says "don't rock, you're rocking!!! I think sometimes they feel they just need to say something!!!

tridil2000, MSN, RN

Has 34 years experience.

Did you get your first three? I'm 0 for 3 now, and getting frustrated. The first time, I couldn't get a view of anything. I felt better about that one though after the CRNA I was with said that the patient's airway was odd (it was deviated far to the left), and he had a little trouble visualizing the cords too. That's the only one though that I can rationalize by weird anatomy. I've missed two others since then. *Sigh*. I've practiced in lab with the mannequins and such, but it is so different when you're doing it on a live person. Everyone in the OR is staring at you, you're trying to relax and take your time, and suddenly "DING, DING, DING..." - your alarms are going off, and you're thinking "OMG, I have to get this tube in you!" It's just frustrating, and I think I'm the only person in my class to have missed all their attempts so far.

do you ask for "cric" pressure?

that almost always helps.

acls intructor

I missed my first few and then just the other day tubed the goose twice in a row with a Robert-Shaw (very embarrassed). Mind you, I hadn't put in a double-lumen for almost a year. Even the skilled CRNAs I work with miss one once in a while.

Slowing down as another poster suggested makes a world of difference. Try to remember that after an adequate pre-ox in healthy pts, you have minutes to get the tube in. Taking care not to pinch the lips is a good tip. Put the blade in the mouth. Reposition the head. Look for epiglottis. Wiggle the thyroid cartiladge just to make sure. Before you lift, make sure you're off the teeth. Voila.

I know this is a difficult aspect of training, but believe me, you're not to graduate without being VERY VERY proficient with this skill. A few months from now, you won't be looking back. Then you'll start Peds and think you're back to square one....

It is a skill, i missed my first three, and now i miss about every 4th one and its been over a month.....dont worry about it, but i know what you mean, for some reason it is devastating if you can't get it, and then you can't concentrate on what comes next after someone else gets it for you.....and then if you DO get it, you are sooo happy you still can't concentrate on what comes next either:uhoh3: .....all part of being a new student:rolleyes: .

louloubell1

Specializes in Anesthesia.

This is why I love this board! Everyone has given me good suggestions and provided me with enough encouragement that I don't feel like such a loser anymore. Thanks guys! :)

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