Today was my first monday of third year. But today felt like every other day on anesthesia rotation since the hospital only casually acknowledges weekends. Today, however, we were suppose to page Dr. Chandler, a woman with lofty ambitions about what the new anesthesia rotation will be like. She was on vacation all of last week and this week she is on call for two of our 5 days with her. She has still yet to make out our test for Friday, which is great. We are hoping that she uses the one from last year.
As far as getting to do stuff today, I go to intubate two people today, each with a nasal intubation. They were having surgery on their mouths which required them to be left accessible to the surgeons. So the tube when in their nose and down in between their vocal cords. The first patient I got with no problems. He was young and really healthy. He was having his jaw broken and reset.
The second intubation I wasn't able to get. The CRNA I was following likes to use a straight Miller blade rather the a curved Mack which I have learned on. Although the concept is the same, there are small difference between the two. The Miller relies on the aligning of the planes in the mouth by positioning in order to see the cords. It also requires less strength as the alignment of angles is doing all the work for you. This technique takes more time to learn. The Mack is great at pushing fatty tissue out of the way and holding large tongues to the side as you look for the airway. It's curved and more easily allows you to follow the pathway to the back of the throat if you haven't gotten the angle perfectly.
Both blades work the same way and it's really a matter of preference. There are many ways to establish and airway for a patient, it's all a matter of what you have to work with, both in your patient, your equipment and your own knowledge.
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