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Is endotracheal intubation becoming a lost art?

Endotracheal Intubation

Have you found yourself spoiled to the new intubation gadgets that are now on the market? I will admit, they are nice to have; you don't have to get so close and personal to the patient's face and can view the airway by way of a digital screen, it's easy to visualize the vocal cords, and doesn't cause as much strain on the jaw and airway. Intubation success with devices like the King Vision and the Glidescope definitely prove their worth and increasing presence. You try to hand a larngoscope and blade to most ER physicians nowadays and they are gonna look at you like you just dismounted a UFO from Mars. I am not here to knock them completely, I am simply asking if you are still practicing with a laryngoscope and blade and still working that muscle memory for intubation. I am a firm advocate for ems personnel practicing intubation every shift and going through your procedure so that you aren't fumbling with all your equipment while a patient is desatting.

Another issue that you will inevitably run into with the new equipment is getting junk like vomitus or blood on the camera screen so you aren't able to see clearly, and then there is always the risk of equipment or battery failure. Are you still prepared to intubate with a larygoscope if any of that happens, or are you just going to stick in an I-gel or King airway? I used to jump on my ems trainee's butts if I saw them immediately reaching for the King vision for every intubation. If you have assessed the patient's airway and determined their Malampati score and know they are not going to be a difficult intubation, why not use a laryngoscope and keep up that muscle memory and practice. The first time you HAVE to do that, you will be glad you did occasionally. Intubation is not the easiest skill in the world to perfect, and pre-hospital intubation success rates prove that, hence the reason some states and ems services are considering, or already have, taken intubation away from their paramedics. I do not believe there is enough training on intubation during paramedic school, and they are only to required to intubate anywhere from 2-3 times, in some schools, to be "checked off," and those intubations usually occur in a surgery room. This is a controlled environment with all of the most ideal situations possible, because obviously, that's exactly how it always happens in the field, right?!? Many of these patients in this situation could be intubated from across the room. And I mean no disrespect to any anesthesiologist by saying that, they get their fair share of difficult intubations and are excellent at what they do, but they have already assessed the patient and determined it was a patient worth letting a student intubate. I highly doubt they are going to give a student an airway they would have a hard time with. So, at best, some of the new paramedics on the street have had maybe three easy intubations and have never practiced with truly difficult situations like obesity, airway and/or facial trauma, kids with special needs, esophageal varices, and a whole lot more.

Not only is it vitally important for you to practice DAILY on your intubations, I highly suggest you take an advanced airway or difficult airway course at least once in your career. If you are in a high call volume system and you get a pretty decent number of intubations, then great! But you still need to prepare for those more difficult airway intubations. And if you work in a more rural area where you might see an intubation every month or two, you dang sure better be practicing and working on that muscle memory or you are going to get caught with your pants down on a call and the only one that is going to suffer for your lack of preparation is the patient.

Please, contact us if you would like to join us for one of our difficult airway management (DAM) courses, or if you want for us to come to you and your department to put one on. We will be glad to have you, and you will be glad you did. You owe it to your patients to practice intubations everyday and to prepare yourself to give them the absolute best care you possibly can. Our difficult airway course is an 8-hour course that has classroom instruction as well as in-depth skills practice that will leave you much better prepared and more confident in your airway management skills.

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