Intubations

Just a quick question...

Tomorrow I go for my first time to intubate in the OR. I am doing this because I am working on getting my PHRN(prehospital RN). Any tricks of the trade, tips, ect.. would be appreciated.

:cheers:

First off, congrats on your choice to become a PHRN.

Remember anatomical landmarks when intubating, it's a bit different when looking down at a real trachea than it is when you're looking at Fred the Head (intubation mannequin).

Keep the laryngoscope firmly gripped and remember to "slide" the scope up and down as if it were attached to a pole if you need further visualization (I wish I could draw this so you wouldn't get confused). This will keep you from rocking back and forth and possibly chipping teeth or causing some other oral trauma.

Go easy when you insert the laryngoscope, I've seen some people jam it in the mouth and you'd be amazed how much a tongue will bleed when lacerated by an object that doesn't look like it can cause much damage.

Time is of the essence anytime you're doing intubations, so once you're done preoxygenating the patient, get the scope in quickly but smoothly...find the trachea, and aim for it with your ET tube. The stylette is a wonderful peice of equipment...and your patient's airway will dictate it's shape and use. Once you see the angle of the airway you can better judge what to do with the stylette. And remember not to let the stylette extend past the end of the ET tube (common sense but never hurts to repeat).

Just remember to stay calm, this is your learning time. Listen to the anesthesiologist and ask questions about technique or for any tips they might have.

It's a great skill, and one that is an absolute "must do right" for a field provider. Best of luck!!

vamedic4

:yeahthat:

very well put vamedic4!!!!~~

Well... I went to the OR only had one chance....and that one didnt go to hot. Keep ya updated, thanks

See what works for you best and try out different things....It seems like many people (incuding myself), like using a MAC 3. Another really great technique (especially for difficult airways) is to use a a gum elastic "bougie". You can use this to intubate the trachea while having the ETT "preloaded" onto the bougie....If you don't have a great view or your not sure, you can insert the bougie and advance it down...If it "stops", you probably are in the trachea and have hit the carina....If if "keeps going in" your probably in the esophagus....Don't get discouraged, we all have missed an airway! Keep on trying and good luck :)