“Clank. Clank. Clank.”
That’s the sound of an intubation gone wrong. My first intubation attempt on an actual patient ended with that obnoxious noise of metal hitting teeth. Oops.
The patient was a younger gentleman who had clearly had way too much of something you should not have way too much of. Heroin? Methadone? Ecstasy? Who knows. It didn’t matter. The ER attending felt that he was probably incapable of protecting his airway in his current state. Understandable. But as far as “controlled situations” in the ER, this was one of them–a perfect chance for a student to lose his intubation virginity, so to speak.
But, alas, I struggled with my scissor fingers. I fiddled with the tongue too much. I never saw cords. Clank. Clank. Clank. Dr. Attending took over. “Better luck next time”.
So today when I had another shot at intubation, I was determined to succeed. The pre-op anesthesia scenario is the most controlled of any intubation situation. There was a resident and an attending at my side. No way I could screw this one up.
A few pushes of some fancy drugs and the patient left for La La Land. Time to…er…”shine”.
Step 1 is easy enough: prove you can bag the guy. Left hand on mask, right hand pumping away at bag. Attending calmly pointing out, “you need to keep breathing for him. He’s relying on you. Keep breathing for him. Keep breathing for him.” I got the point.
Bag. Bag. Bag.
Now, give me the blade (Note: do anesthesia guys envy surgeons or something? Seriously…call it something else). Scissor fingers working nicely. Not great–but better than previously.
Blade in. Tongue…in the way again. Step back in my head for a second–readjust blade to the right. Tongue way out of the way.
Epiglottis in view. Don’t torque the blade. Lift. Lift. Lift.
“Do you see cords?” You gotta visualize the vocal cords before you can shove the tube in.
“I see a very small hole…” I suddenly forget I’m a med student. Small hole? Are you serious? That was my response?
“Um, but do you see cords?”
“Oh…yeah, I got cords”. Much better.
Give me the tube. Tube in. Through the cords. Down. Down. Down. Hold tube. Remove blade. Hook up bag. Wait.
In a proper intubation, oxygen goes in the tube and down into the lungs where tiny anti-environmentalists turn it into carbon dioxide. Al Gore hates this. The anesthesia folks have a nifty machine that measures the CO2 coming out of the tube–no CO2 means no “proper intubation”.
I got no CO2. Ugh. Al Gore gets payback for me not voting for him.
I pulled the tube and stepped out of the way while the resident took over the case and made sure the patient regained his pink hue.
Oh well. There’s always tomorrow.
Such is the life of a medical student.
March 6th, 2007 at 1:59 am
My first successful intubation ended with the anesthesia person grabbing my wrist to keep me from advancing the ETT all the way into their distal bronchi. I was so excited to have gotten the tub in I just kept pushing.
Heh. As much as my hands were shaking I’m surprised I could use them.
March 6th, 2007 at 6:13 am
MedBlogs Grand Rounds 3:24…
Thanks for coming! It’s an honor to be the first four-time host. As for how much things change, here’s the first time I hosted (November 9, 2004, #7). The biggest change is the number of blogs, hence submissions, and the quality…