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Monday, December 7, 2009

Old Dog Learns a New Trick

At my age and position in life, it's not every day that I learn a new trick, but early this morning I intubated a woman with our new video laryngoscope. A first time trick for me.

Now, video laryngoscopes are nothing new, they have been around for a while, but since they are quite expensive, it took a long time for our small place to afford one. After all, we only got penicillin a couple of weeks ago.

Anyway, if you've never really intubated someone you'll have no true frame of reference here, but I'll do my best to share.

The old method entails using a standard laryngoscope, which is nothing more than a flat, curved or straight piece of metal with a light on the end. The trick is to slide the thing over the tongue and into the throat, visualize the vocal cords, and then with your free hand, pass an endotracheal tube past the vocal chords into the trachea. Unfortunately this is not always as easy as it sounds. Sometimes the tongue gets in the way. Sometimes you can't see anything except secretions or vomit. Sometimes a person's anatomy is different enough from the norm that you just can't find the trachea. Oh, by the way, if the patient is awake, as this one was, you have to sedate and paralyze them first. You can imagine that awake and alert people don't particularly like tubes shoved down their windpipes.

These problems are supposed to be minimized with the video laryngoscope. Our particular scope has a light and a camera lens on the end of the blade. You simply insert the device into the mouth and look at a small TV screen on the other end (it's in COLOR!). So far so good, but I knew right away this whole thing was going to be different. I got no physical sensation of wrestling by the tongue. Some people have very big and uncooperative tongues. I had to resist the urge to look down the patient's mouth and instead focus on the TV screen. I had to resist the urge to pull the scope upward against the tongue (not necessary unless you have to look down the mouth). The vocal chords miraculously appeared on the TV, but it was not like looking at real vocal chords but rather more like a picture in a text book.

When it came time to pass the tube, again I had no physical cues of the distance of the tube tip from the trachea. When you're looking down the person's mouth, you kinda lnow where the tube is the whole time. I just had to advance the tube and wait for it to appear on the TV. Suddenly, without warning or fanfare, there it was.

Then I had to manipulate the tip of the tube into the trachea. This was not an easy task at first and it seemed like I was actually disconnected from the tube and I was moving it by some kind of remote control. Anyway, with a bit of wiggling and jiggling I finally got it past the vocal chords and all was well.

Strangely, the whole thing kinda reminded me of when I got my electrically steered, autopilot trolling motor for my boat. I know, it's a strange analogy. The old trolling motor had a mechanical linkage to the foot pedal. I got a constant feedback as to the position of the motor through my foot. When I went all electric, there was no more feedback. I had to actually look at the motor head to determine the position. This took a bit of getting used to, but with the precise steering, the infinitely variable speed control, and the autopilot, I wouldn't go back to the old unit.

So there ya go. If you need a tube shoved down your throat, come see me. I'm your man!

Hey! It's not every day you get a free lesson on intubation!

3 comments:

  1. That makes me gag. I'm assuming there is some sort of numbing medication??? NO??? OH MY. I'm assuming the patient is no worse for the wear? Is this a new toy the hospital has purchased or are you just playing with it and considering purchase?

    It sounds like it would be easier on the patient that the old way.

    Debbie
    Right Truth
    http://www.righttruth.typepad.com

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  2. The hospital owns the device. We put the patient out with Versed and Anectine (paralytic) so they don't feel anything.

    In this case the patient is ALIVE because of this. Would have been DEAD otherwise.

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  3. Quite a lesson "Doc", you should open a practice in Frisco---a certain group would be lining up at your door. Don't think I'll go into detail!

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