is it muscle or technique for intubating?

DreamMatrix · Apr 12, 2005

Hi all,
It's been a while since I posted (adjusted to the shock of starting classes 3 months ago and all the studying/tests etc). We practiced intubating the mannequin yesterday. I had a really hard time lifting the mandible with the MAC blade (miller seemed to work a little better) but with both felt like my arm was straining. I purposefully made sure I wasn't using the wrist bending action and was lifting up and away but still felt like my arm was going to fall off! I also did not use the 'chicken arm' move but kept my elbow close to my side. My 2 other female classmates said their arms were straining as well. My instructor said it doesn't require muscle we just need to work on our technique (some of the guys were straining also).
I'm really worried that I won't be strong enough to intubate. I know they say it's technique, so how long does it take to acquire technique!! We start intubating in the OR next week!!! Any tips (I'm really hoping it's was just hard on the mannequin because it is so stiff and on patients their jaws will be a little more flexible!). HELP!!

You do have to be strong enough to lift the patient's head. But it really is technique. How long it takes to acquire technique will vary with each person...but, repetition will do the trick. Its like anything, the more you do it the better you get. Just be patient and don't get to down on yourself...you will always be your worst critic.

DreamMatrix

athomas91 · Apr 12, 2005

don't judge how you did on the manequin...although a help - we did it as well - it is nothing like intubating a real patient. you will have good clinical instructors who will teach you exactly how to be an expert at intubating - don't sweat it.

snowfreeze, BSN, RN · Apr 12, 2005

The manequins are more difficult in my opinion than intubating live humans. Learn the technique and then fine tune it and learn more. I found cadavers about the same as the manequins as far as difficulty. When I learned neonates we intubated live kittens and that was so useful. You had to do the anesthesia along with intubate, figure when they were awake enough to extubate then personally take care of them until they recoved after the ordeal. All the kittens were adopted by employees after each class. That hospital only does that class once a year but if you can find one, please take it.

DUCKGIRL · Apr 12, 2005

Hi all,
It's been a while since I posted (adjusted to the shock of starting classes 3 months ago and all the studying/tests etc). We practiced intubating the mannequin yesterday. I had a really hard time lifting the mandible with the MAC blade (miller seemed to work a little better) but with both felt like my arm was straining. I purposefully made sure I wasn't using the wrist bending action and was lifting up and away but still felt like my arm was going to fall off! I also did not use the 'chicken arm' move but kept my elbow close to my side. My 2 other female classmates said their arms were straining as well. My instructor said it doesn't require muscle we just need to work on our technique (some of the guys were straining also).
I'm really worried that I won't be strong enough to intubate. I know they say it's technique, so how long does it take to acquire technique!! We start intubating in the OR next week!!! Any tips (I'm really hoping it's was just hard on the mannequin because it is so stiff and on patients their jaws will be a little more flexible!). HELP!!

I don't intubate pts...I am "just an RN!" but I have taken ACLS and have been a volunteer EMT for years and have seen many paramedics in action...I will never forget one paramedic teaching ACLS who gave me the tip...when you are intubating think of "toasting" instead of "chugging" with your forearm. I'll be darned if that isn't what it looks like out in the field!!!

apaisRN, RN, CRNA · Apr 12, 2005

I had ACLS today and this was my exact experience. I could see where I wanted to go but it took all my concentration to hold the blade up. I guess it's like any other motor skill - over time you develop both the strength and control to perform it.

medic1488 · Apr 12, 2005

Mannequins are horrible to intubate. In my experience for the great majority of patients, technique is much more important. The mannequin is usually much stiffer, no floppy tongue, and the head seems to come up off the table before anything moves inside the mannequin.

snowfreeze, BSN, RN · Apr 13, 2005

yes with mannequins there is no body weight and the head weighs so much less than a live human. I learned to straighten the arm after you insert the blade, that gives you more shoulder muscle use than wrist. Place yourself so you will look directly at the cords when the jaw is open and the blade is in...adjust the bed for your height..not the instructor or preceptors height. If you need to adjust your view by lowering or raising your head, then the bed is at the wrong height for you and you will find stress in your arm.

You will learn what is your best height or position with time.

miloisstinky · Apr 13, 2005

How funny, intubate a kitten and adopt it after emergence.:chuckle I was told that dogs were intubated by feeling the epiglottis and then simply placing the ETT in the trachea....by feeling. By the way, how do you DL a kitten? The anatomy can't be that similar to a neonate, or am i wrong.

medic1488 · Apr 13, 2005

Cats are pretty similar (ours werent very adoptable, the smell of fermaldhyde (sp) was kinda a put off). And digital intubation (like the dogs) is done on humans also. Rare but its in our skill set for airway control in a situation were we cant get into a postion for direct larynscopy and a Blind nasal is contraindicated.

Laughing Gas · Apr 13, 2005

Try not to have blinders on. Try to pay attention to what works for you and what doesn't. Each pt may require something different, but there are things that may play best into your hand.

It is 99% technique. After you have gently placed the scope, the strength to lift the head into the sniffing position will make a hopeless airway magically appear. Visualize what you are trying to do. Picture the anatomy and how it moves.

gaslinq · Apr 13, 2005

Remember that when intubating a live patient, most of the time, you will be giving a full-dose muscle relaxant unlike with a mannequin. It's more of technique than strength. Take your time, find the right table height that works for you, position the patient so that the oro-naso-pharyngeal access is ideal, use the blade that you are most comfortable with and it should not be difficult for you.

Try not to have blinders on. Try to pay attention to what works for you and what doesn't. Each pt may require something different, but there are things that may play best into your hand.
It is 99% technique. After you have gently placed the scope, the strength to lift the head into the sniffing position will make a hopeless airway magically appear. Visualize what you are trying to do. Picture the anatomy and how it moves.