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Wednesday, April 30, 2008

Tubed the Goose

Today I had airway in the OR...I missed an intubation for the first time. But I don't really consider it a bad thing. I had to miss sometime, and this patient was very difficult. I tried a different laryngoscope blade, because I've used the same one for my first 5 intubations and I wanted to try the other one. This patient had an excellent airway exam but once he was induced he turned out to have a very poor (Grade III) view, in other words, no cords to be seen anywhere. I tried anyway, tried to direct the tube where the trachea should be, but "tubed the goose" instead (intubated his esophagus, or 'goose'). The CRNA I was with tubed the goose after me, and the MDA ended up having difficulty too and used an Eschman stylet to intubate the patient. So I didn't feel bad for not getting this tube, AND I got to see what a Grade III view looks like, for the first time. The Dr. got on my case for trying a new blade so early, but we've been encouraged to try both blades the whole time by John, our airway instructor, and the CRNA also said I did fine and there's no problem trying a new blade, especially on someone who had a good airway exam preop. So I really felt okay about the whole thing. The patient was easy to ventilate between intubation attempts, so there shouldn't have been any pressure, and I really wanted to try again with the Mac blade, but the doc was feeling the pressure of the room, which was a case done by a surgeon who has a history of anger management problems, so the whole room is always tense for his cases. So she just intubated the patient, and that was that. Still, a good learning experience, and I got my first "miss" out of the way so I don't have to worry about that coming. I think when I do IVs on Tuesday I might stay for an airway when I'm done...we'll see.

Just got back from a swim a few hours ago. I got in 40 laps in 30 minutes. It was very tiring. But I felt pretty good. I kind of felt like running instead, actually, but I wanted to stick to my plan of running every other day. Twice a week weights...I'll do them once this weekend.

We got a long weekend, early! We're supposed to have class tomorrow, but one thing happened and then another, and all our classes ended up being cancelled. So I'm taking the train to Portland tonight, yay! It will be nice to be out of Spokane for a few days. I have major studying to do for our A&P exam on Monday, but otherwise I'm in good shape I think.

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