Tuesday, September 3, 2019

100 airways

Last night I had a nightmare.  Actually I had several (it was one of those nights), but the one I remember most clearly was one in which my daughter fell off the monkey bars and I called 911 to bring her to the ED because I suspected a c-spine injury.  When we arrived at the ED they were like, "She needs to be intubated, get the ED fellow," and I said (IN MY DREAM), "No way in hell any ED fellow is going to intubate my daughter with an unstable c-spine." And then I did the intubation myself.

As so it was that I ended up working with an ED fellow in the OR the very next day (surprise!), who is learning how to intubate.  She seemed nice, and could actually mask ventilate effectively, which in my opinion is an even more valuable skill than intubating.  However she really struggled with the intubations, and I had to take over each time.  (All patients were completely unscathed, which is the norm, in case anyone is worried about having learners involved with their child's care.)  She wanted to know when it would get better. 

I guessed when she had done around 100 airways it would begin to feel easier to her.  I've done probably 2000 airways, and after a while finding your view just becomes second nature.  You stop feeling your heart accelerate when someone passes you the laryngoscope.  You know how to position the patient effectively, and scissor open the patient's mouth in a way that actually works.  I try to remember that the racing heart and the shaky hands are what my learners are feeling when they go to intubate, and be patient, but I am still struggling with knowing how to help them most effectively.  I do think part of it is just doing a lot of airways.  Over and over and over. 

It's actually kind of a pet peeve of mine that learners come to the OR just to learn to do intubations because I think a lot of people leave with the misconception that anesthesiology is mostly about intubating the patient and not much else, and they devalue our skills.  Airway is quite important!  But there is just so, so much other thought and planning that goes into an anesthetic. 

But anyway.

It was otherwise a fabulous day.  I was originally providing anesthesia for my own cases, and then I got an actual emergency put in my room that required a more extensive line up and resuscitation, and I got a lovely anesthesia fellow to work with. 

I love being an attending so much. 

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