Thursday, July 2, 2009

Intubation workshop

I knew there was a reason I wanted to come to this program. They held an intubation workshop for the interns (formal advanced airway training is during second year, but they want us to at least have a clue). We walked into the room and rather than intubation supplies, the first thing we saw were splinting supplies.

(To catch my non-medical colleagues up, to intubate someone is to put a tube down their throat so that you can hook them up to a breathing machine. It is a definitive airway for patients who can't breathe on their own. No breathing = no life, so, it's important. Splinting is applying a strip of plaster cast to stabilize a part of the body and then wrapping in an ACE bandage.)

What the hell does applying a cast have to do with intubating a patient?
The pictures below illustrate what happens if you move your wrist to rock the blade back and forth... you knock out your patient's front teeth. Yet that doesn't stop most young doctors because the more natural thing to do when you can't see is to rock your wrist. BAD. You're supposed to pull UP towards the far corner of the ceiling as in the second picture.

So, how did we look while trying to do this?

Yeah EM interns!... No opportunity for wrist movement this way. (I am totally the shortest person in my class by far... Joyce, Edozie, Debbie, me, Rishi).

The thing is, this is BRILLIANT! I have been to many intubation workshops before. During Anesthesia as a third year medical student, Emergency Medicine three times (one on each rotation) as a fourth year medical student, ACLS this year, and yet I NEVER GOT IT RIGHT. This time it was easy as pie. Two seconds and I had a perfect view (you have to view the vocal cords and watch the tube pass between them, otherwise you're just going to end up ventilating the patient's esophagus, which lies right behind the airway) and in another 2 seconds, I had an airway. 5 previous intubation classes and all anyone had to do was put a cast on my wrist. So impressive.

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