Intubations in the OR

[Carlos Danger]

I couldn't agree more, and I'm in NO WAY at all trying to advocate for preventing paramedic students from doing intubations in OR environments. I, as a patient, would just like to be ASKED first, before an invasive procedure like that is performed on me by a student.

A great many people will not have any issue at all with it. A few will, and in a non-emergency environment like an OR there is time to talk about it with the patient.

Not necessarily.

When I did my OR intubations as a paramedic student and later as a flight paramedic and flight nurse, I never had any opportunity for interaction with the patient.

In a busy surgical suite first thing in the morning, you may have 5 or 10 cases starting at pretty much the same time, and the time I was instructed to arrive was usually just few minutes before that. As someone who is there to get practice intubating, I would get shuffled from one room to the next with just enough time to walk in as they were giving propofol, mask for a minute, place the tube, tell the anesthesiologist or CRNA "thanks" and then get shuffled to the next room. It's not ideal, but I think it's pretty common.

You can make the argument that I should have gotten there early enough to introduce myself to all 5 or 10 patients and ask them if they'd mind me doing their intubation, but again, I think that's impractical.

And I also think it's unnecessary, given that these were teaching hospitals where students are the norm and where the patients already signed a consent saying it was OK with them if students were involved in their care.

Compassion much? :unsure:

Yes, I understand what intubation is, and I understand the mechanics of WHY I could barely talk for two days and hurt like HELL for two weeks. I get it. That doesn't mean we shouldn't show some sympathy for someone in pain, or suffering from some massive anxiety, for whatever reason they may be hurting. Isn't that part of what being a healthcare provider is?

The point is that a sore throat is common and has nothing to do with students.

It has nothing to do with compassion, or lack thereof.

 

[jwk]

The point is that a sore throat is common and has nothing to do with students.

It has nothing to do with compassion, or lack thereof.

Bingo!

Some risks are assumed with anesthesia. In addition to sore throat, nausea, vomiting, etc., dental injury is also an assumed risk. Far more likely than not, if a tooth or dental work is damaged, it's not going to be paid for by the hospital or anesthesia group. The risk is there and we warn every patient of the possibility. Again - it has nothing to do with compassion or lack thereof - sometimes unavoidable things happen despite our best efforts. It doesn't happen often, but it does happen.

 

[VirginiaEMT]

This is a completely different experience than I had. I was allowed to intubate every patient I came in contact with. I would say that learning how to ventilate a person properly is the biggest thing a paramedic student can take away from the O.R. experience.

I went to the OR for intubation practice for my new job today. Let me preface the rest of this post by saying what a good move I think that is. This obviously doesn't fix all the controversy about paramedic intubation, but sending all new hire medics to prove competency in the OR prior to being released seems like a great commitment to quality service to me.

I am looking for some feedback from others though now that I have done intubations in several hospitals.

What is everyone's thought on the narrow range of patients most hospital staff are comfortable letting the paramedic intubate? I really can see thei Anesthesiologist's side of the equation, as I understand the patient is their responsibility and having someone they just met step on their toes cannot be comforting. At the same time, I wonder how smart it is to only let paramedics intubate the easiest patients in the OR. Let's be honest, the 25 year old athlete with a Mallampati of 1 who is already paralyzed doesn't really present any challenge. I don't really see consent being much of an issue either. Most consents can be acquired just by the way it is presented to the patient. They obviously shouldn't be forced at all, but the anesthesiologist asking if the patient minds if they supervise a paramedic as they intubate will most likely be met with approval 9/10 times.

In some ways, I wonder if paramedics should only be attempting intubations on at least moderately difficult airways in the OR. This can certainly leave out extremely high risk patients or those that are deemed to be too difficult for the paramedic to even attempt. This should only occur after familiarization with normal airways and anatomy of course, and only under the direct supervision of the anesthesiologist. Realistically, most airways we manage in the field are difficult in some way. What better place to get practice on varying airway anatomy and pt. size than in a controlled environment with an expert immediately available to correct mistakes, teach, and obtain an airway if necessary? The current model of teaching on simple patients and then throwing new medics to the wolves by intubating elderly, obese patients or children seems intrinsically flawed.