Intubation

I'm so excited about what I'm doing and seeing I wish everyone could experience the excitement and thrill of being able to be a part of saving a life or making someone's life better.

First off, a little bit about intubations. They are only done when necessary to do major surgery. This is to put you into a deeper sleep than what you would experience at the dentist office, although some of the same medications are used. The reason a patient is intubated is that the procedures that are done couldn't be done when the patient is awake because they would be far too painful. The procedure goes something like this.

The patient is brought into a waiting area, where their family waits with them and the doctors come by to see them and check everything over one more time before they go to the room. The trained nurses put in ususally 1 IV in which to put the medications/fluid/etc into the patient. They usually receive medication for nausea/anxiety at this time if they want it. Then pain medication is given. They are then taken to the operating room with the nurses and CRNAs. The room is preped and the patient is made as comfortable as possible, usually with warming blankets, etc. Everything is set up and the patient is moved to the operating table. After they get comfortable and properly positioned on the table, they are given some pain medicine and ususally a muscle relaxant. They then go to sleep by breathing in oxygen. After they are properly sedated a tube is inserted into their mouth (intubation) in order to breath for them during the procedure. This is to enable the patient to be put into a deeper sleep so they won't feel any of the pain during the surgery. After this, sometimes an additional IV is placed in the other arm. This is the one that is available to be tried by students because the patient is alseep and muliple sticks will not annoy the patient. A trained professional is watching over your shoulder at all times and helping to prevent you from doing anything that would harm the patient. This second IV is usually only used in emergency cases but is good to have for precaution sake.

After the patient is intubated, they are constantly monitored by the CRNAs watching the blood pressure, pulse, temperature, air saturation, amount of air in, the pressure of that air, the amount of gas and the physical actions (if any) of the patient. The body has a lot of reflexes and if the patient moves during surgery, it is always reflex actions. These are not conscious movements because the patient is not conscious.

The pain medicine that is used works on the pain receptors in your brain so that they are no longer firing (same as Tylenol). They also have an amnesia affect very similar to what you would think of with alcohol. Time passes, but you don't really remember what's going on. The drunk affects or amnesia effects of these medicines is an added benefit and not the main cause for the use of the drugs. The recommended dose of the drug is the amount of drug needed to remove pain in 50% of people. Some people's pain receptors are more resistant to these medications than others. But the amnesia effects (just like in alcohol) are always affective at the recommended dose in everyone. the benefit to the amnesia (and it's only a benefit and not the main reason for the use of the drug) is that if the person doesn't respond to the recommended dose and feels any discomfort, the amnesia is in effect, so the CRNA can focus on fixing the dose rather than on the fact that the patient is experiencing pain. These nurses and doctors are very attentive and right down vital signs including blood pressure, pulse, temperature and how much air and what pressure the air is at every 5 minutes. Each of these inducators helps the nurses/doctors to know the state of the patient, whether they are resting comfortably or not. They are constantly adjusting the gases in order to keep these number in tight ranges and therefore the patient stays as comfortable as possible.

Intubations and gases which happen to produce amnesia but also anesthesia (or no pain) are life saving. The reason I was unable to intubate my patient today was because she had an ectopic pregnancy or a baby growing somewhere other than her uterus. God made us very well and has a special place for women to grow babies. Babies grown outside of the uterus cannot survive for lack of room and access to nutrients. What the baby can do is grown big and into things, rupture and lead to the death of the mother because of massive blood loss. That's what this woman had. She was bleeding on the inside and feeling excruciating pain. You couldn't touch her belly without her crying. The pain medicines and intubation allowed the surgeons to go in laproscopically and remove the ectopic pregnancy, remove the blood and stop the bleeding.

Intubation saved this woman's life and many others each and every day. The nurses/doctors are not naive. They are aware that nothing in medicine is benign or not able to hurt you. As some physicians like to say: every drug (or thing you put in your body) is a toxin, in the wrong doses can be lethal. Just think of the woman who drank too much water. Even water can be toxic. Therefore, the decision to do a procedure under anesthesia is not taken lightly. There are risks involved and they are most definitely considered. As many physicians have said: medicine is all about risk/benefit. Everything has potential to hurt you and lots of things have the potential to help. It's about the risks verses the benefits that have to be considered for every patient, every time.