Hospital ORs suck!

[Onceamedic]

I'm here to whine... (forewarned is forearmed)<_< I had my first clinical shift in the OR. The purpose is to practice intubations. I have been doing ED clinicals for the last two months and forgot how intimidating new environments and new people can be.
I got to the department and changed into the surgical scrubs, booties, etc. etc. The receptionist took me to meet the anasthesia staff. We walked into the pre-op holding rooms and the head guy turned his back on me, didnt want to know my name - said "We are really busy today - stay out of the way". It didn't get much better.
My first ever intubation attempt ever and I was checking my gear. I asked for a stylet for the tube. The anasthesiologist says "I never use 'em - and if you want to intubate my patient you don't use one either". Well, he's the doc - I had a great view of these chords but I couldn't get that stupid tube into that big ole hole without a stylet. Failed! Second patient - the RT tech did not preventilate adequately. (Did I mention they were really busy ? ) Big fat guy - just got into his mouth and his stats fell and I was ordered away from the cot. They ventilated again and did not give me another run at it. Bottom line, I didnt suceed one single time out of 4 attempts. I only got the attempts because I was chasing nurses down the hallway trying to find out if the patient was an ET, spinal, LMA or what and then latching on like a lamprey if it was an ET. (I did drop a bunch of LMAs) Did I mention the guy who's tristus was so severe that I actually hurt my fingers trying to pry his mouth open ?
Needless to say I'm a little down but if they think they can beat me by making it hard for me they've got another think coming. I have the hide of a rhinocerous and will do everything in my power to get those intubations.
Thanks for listening... I actually feel better.

 

[cw15321]

At least they let you try!!!!!

During my OR time all the pts that they had scheduled did not need to be tubed. As we had to get at least four attempts for the class, I had to go back for another shift.

Well, day 2 and I was told that I was just to watch. In their world all the other medic students in the past screwed everything up, and they did not want to take the risk. So I did another shift without doing anything. :angry:

I did eventually get my tubes, but all 911 calls with the local FD. I felt that my time in the OR was a complete waste of time. Just wished I had done my time in a teaching hospital.

 

[Ridryder911]

First.. take a deep breath.. you will do better next time. Second, yes welcome to medicine.. grown that tough hide. Heck, I have seen surgeons throw instruments across the room and yell and scream, all because their coffee had got cold!

Surgeons and usually those associated with them are the biggest pansies there are. A bunch of whining brats! I have to admit, they are a different breed of people.

Now, toughen up... stand your ground. Inform them, you realize and emphasize you know they are busy... sorry! You are there to learn and have objectives to meet... the main one is to learn proper intubation skills.. might remind them, you don't want them or their loved one to be the first patient that you get to intubate... * remind them, it will be in a moving ambulance with vomitus, as well as probably facial fractures.. so yes, you will have to be not just good, but damn good ! Now, Doc.. what can you teach or show me to be that way ?

Usually, they will agree that we have it tough... after they get over the MD'eity.

Hang in there... even bad clinical experience is good. Now, you have definitely seen that is not even similar to t.v. or even textbooks. I wished I could say it was an isolated place.. but I not yet seen any different. Even those in major Level I trauma centers..

Good luck !

R/r 911

 

[Epi-do]

We have already been forwarned that when we start doing OR rotations that we will probably have to do at least one more rotation that required to get the tubes we need. We have been told that there are some good docs to hook up with, but the egos far outweigh them. At least our OR rotations aren't at the same time as when the new residents arrive. From what I have been told, you might as well forget getting any tubes at all when that happens.

 

[Onceamedic]

I guess I was pretty naive. I appreciate the feedback. I have a total of 5 OR shifts scheduled and let me tell you, I am not looking forward to them. They are two weeks apart so every chance I get (cause we all know how much time a person has available in paramedic school) I will be practicing on the mannequins. Thanks again for the responses.

 

[triemal04]

Don't sweat it, and just let that skin get thicker; you're going to need it during your career.

And don't discount what the anesthosiologists want you to do while tubing for them; when I did mine a couple had different tricks they did that I hadn't seen before which were great to learn. Each one also made me use a Miller after I said I preferred the Mac. (that was a good thing just so you know) Even if it's a bad day, you should be able to learn something while you're there, even if it's not what you wanted. Go and watch some operations, talk with them about how they sedate people and keep them under, signs that a pt may be paralyzed but still awake, how to avoid difficult intubations or how to get around them...you can find a wealth of knowledge if you don't mind asking or taking a bit of abuse sometimes.

 

[Greg]

Sorry to hear that...my experience in school wasn't too much different. I think a contributing factor is that the OR staff doesn't have as much understanding of emergency medicine and as much appreciation for the technical skills we need to do our job as the ED staff has. I'd get looks from nurses that pretty much said "You're a Paramedic student? Shouldn't you be practicing cot-pushing or something?" "somebody help me, i'm dying from all the smug in here..." One thing I figured out quickly is that the CRNAs are really cool (at least the ones that let me intubate). Ask questions and engage them in conversation so you can learn from the people who have experience in airway management, and so they can better understand what knowledge you have. Also, as bad as they might treat you, just remember that they have a TON of liability resting on their shoulders. To hand over management of the airway to somebody that they've never seen demonstrate skills before is entrusting you with a lot.

 

[RALS504]

+1 for CRNA. I had a awesome one for my clinicals. She let me do way more than the MD. I have noticed that if your IV skills are sharp OR staff give you much more latitude. I had an emergency C-section in L&D. Pt was hypotensive. The anastesiologist was trying to get a second line and missed an 16 ga ac . So he went to intubate, but did not want me starting an IV. I was persisant and told him I would get it. He finally let me and I got it, which surprised the hell out of him. He literarly patted me on the back after the procedure and said want an awesome & difficult IV. I think if I had gotten the IV before he intubated he would have let me try. Do not forget to mind your manors in the hospital, you are an ambasitor for the entire EMS field. Oh yeah one thing my CRNA told me is that as an occupation CRNA is much older than anastesiology. Hang in there.

 

[Ridryder911]

I would like to add how fortunate all of you are in being able to participate in an OR intubation clinicals. In my area, they are very few and in-between. In fact, most educational institutions are no longer able to provide these clinicals, so only mannequin and field (if they are able to get any) are allowed.

The reason is so many previous problems with EMS students. Breaking of teeth, unprofessional conduct, poor knowledge, etc. was to be blamed.

I agree, it is essential for prepared, but I see more and more institutions are having difficulty in obtaining or maintaining the sites.

I agree, they can be a pain, but as myself and others have mentioned, toughen up and be professional. I might add to read up and more than just was in the Paramedic text. Be prepared to answer questions, and practice multiple times before attending the clinical.

Yes, it is a HIGH liability. I have to admit, after meeting several students, I do not know if I would allow many to attempt as well. Considering it would be my livelihood and increase my liability risks.

R/r 911

 

[firecoins]

MD'eity.
R/r 911

I like that. Can I steal that?


I am going to be in this same tough position soon. In a couple of months I will be entering the OR to intubate. It is a learning hospital but I don't know if it means much. I got yelled at during my first shift in the ER. One nurse asked me to cut off the wet urine drenched clothes of a drunk. I did this. After a shift change, the new nurses needed to discharge this guy. She yelled at me because she had to find new clothing for. I didn't get in trouble but you can tell certain doctors and nurses hate students of any type. God only knows why these people work in a learning hospital.

 

[Guardian]

I'm not writing this to reply to anyone in particular, just a general post on how I feel about OR rotations. Please remember, it is a humungous privilege to be able to participate in OR activities at all, let alone actually getting a chance to intubate another human. You are the representatives of our profession, the up and comers who will soon be on the street. Please, always act with the utmost professionalism. In the OR, you will be surrounded by some of the best and brightest in the medical profession. These people are the real deal. So here's my advice. First impression is everything. Look presentable, speak clearly, and make eye contact. Yes sir, no sir, etc. Talk with the OR staff beforehand, ask questions, and try and establish some sort of relationship and trust. When they go to intubate, make sure they know you're interested in the process. Ask them to show you what they're looking for while intubating. If you lean in, you can see all of the airway landmarks. Ask thoughtful and practical questions that you thought of before arriving at the hospital. Finally, when you feel you've done your best to win them over, press the issue and let them know you are interested in doing as much as possible. If you do these things, you will drop more tubes and gain more valuable insight than you know what to do with.

Sometimes, I wonder if it wouldn’t be better to have a paramedic instructor accompany students, maybe two at a time, to the OR for their first visit. I’ll admit, in many ORs, it can be intimidating. I wonder if it would be better to have an experienced liaison with the students their first time out.

 

[Onceamedic]

I am fully appreciative of the opportunity to intubate in the OR. I was so excited to be going and felt extremely privileged. I made sure to not abuse the privilege also. It was their house and I was visiting. I think you make a very valid point about having an instructor along. Anyone that was "on my side" would have been extremely appreciated. Heck, I would have been happy to have a classmate so that someone would have talked to me during the 5 or so hours of downtime. I introduced myself to the people on my side of the cot. One anestheologist appreciated it and told me so. There were several wonderful people in the OR but the bottom line was still the bottom line. The setup was for the convenience of the money makers. I am grateful that it is not my work environment.
I talked to my instructor about the issue and he told me to try the hospital again. He said that with a different crew and schedule, it might be completely different. I asserted my determination to do as well as I could. He also told me that if my negative experience was repeated, he would assign me to a different site.
Thanks for all the feedback. I really appreciate it.

 

[triemal04]

During my OR time all the pts that they had scheduled did not need to be tubed. As we had to get at least four attempts for the class, I had to go back for another shift.

Does anybody else see that as a bigger problem? That there are programs out there that only require 4 successful intubations for competancy? (I'm going to cross my fingers and hope that you meant intubations and really didn't mean attempts)

Airway management is one of the most important and potentially hardest things we do. Training should reflect that.

 

[RedZone]

Try getting to the OR early and start a conversation with a few of the anethesiologists. Find one that's willing to teach and has a good attitude.... preferably the head if possible. They'll be more willing to let you play and help you out a lot.

 

[Ridryder911]

Sometimes, I wonder if it wouldn’t be better to have a paramedic instructor accompany students, maybe two at a time, to the OR for their first visit. I’ll admit, in many ORs, it can be intimidating. I wonder if it would be better to have an experienced liaison with the students their first time out.

I was just hired to be a clinical instructor. Like nursing, colleges here require to have "in-house" clinical coordinators, that will accompany the student or make rounds to be sure everything is as expected. If there is a problem, it will be my job to make sure it is dealt with appropriately, as well to make sure each students is able to meet their objectives as much as possible. This type of monitoring has been going on for several years as has been proven successful against those that do not have that type of program.

R/r 911

 

[Epi-do]

The program that I am currently in has a field coordinator and a clinical coordinator. Either one of them may pop in at any time during your shift to see how things are going. Our field coordinator also fills in as a preceptor on the ambulance when there is an open shift. If we have any problems at all we have several ways to contact the appropriate coordinator and let them know what is going on so it can be addresses asap. Even though I am going through a hospital-based program, it is accreditted, and therefore has additional "stuff" that must be done to maintain that accredidation.

 

[cw15321]

Does anybody else see that as a bigger problem? That there are programs out there that only require 4 successful intubations for competency? (I'm going to cross my fingers and hope that you meant intubations and really didn't mean attempts)

:blush: Yes you are correct I did mean intubations.

Airway management is one of the most important and potentially hardest things we do. Training should reflect that.

I am lead to believe, but open to correction, that the USDOT curriculum only requires at least that amount (or is it 5):unsure:?

I started my truck time on a small rural volunteer ambulance and for us to get that amount in a whole year would have been a shock. I made the decision to do most of my time with an ambulance service in the suburbs of a city and got much more experience. But, to answer your question, yes there are programs out there that get by with just the basic amount as stated in the USDOT curriculum. I know that there were some in my class that only got the basic amount.

 

[Onceamedic]

I wanted to post an update for you. I had my second rotation at the same surgical department as 2 weeks ago. This time around, it was a totally different experience. The people were just as busy, but there was different personnel. They were wonderful to me - patient, kind and encouraging. I am very glad to have seen this side of it too. I needed to post this in fairness to the hospital. I will be sending them a thank you card when my rotations are over in another couple of months.
PS.. I got 4 intubations and a couple of LMAs.