Tube Time

Endotracheal intubation is one of those skills that you can practice all day on a dummy. In order to successfully intubate, you take a lighted blade called a laryngoscope, insert it into the mouth and displace the tongue while pulling up in order to see the vocal chords. Once you see them, you pass a plastic tube through them, effectively isolating them and providing an unparalleled airway.
Like I said, you can do that all day on a dummy, the anatomy will never change. In a real person, things are all discombobulated. The trachea can be much more forward than the on the manequin. Teeth can be oversized and the tongue can be a floppy mess. A real person is much more difficult than a plastic one because of the intricacies of the human body.
So in order to practice the entubation technique on real people, paramedic interns are required to pass ten tubes in the OR, the operating room. This, of course means dealing with the surgeons. Now, doctors are on thing, they know they know their stuff but they are usually not too stuck up and some of the time, they are nice. Surgeons have an unrivaled god complex and a massive stick up their asses about everything. Despite the fact that all the surgeries in which paramedics intubate are elective and nonemergent, the surgeons act as though they are curing cancer on a daily basis. Apparently tummy tucks and removal of unsightly warts is a crucial and life perserving procedure.
But I digress. Each person has their own unique anatomy, their airway will be different just based on who they are. Perfect, unreplicatable snowflakes if you will. Their are two types of blades that one can use to displace the tongue. The Mac blade is curved and is widely reguarded as the easier of the two. It takes less finesse to use and it offers a wider surface area with which to move the tongue. Needless to say I tried this one first, its easier on the dummy so I figgured it wouldn't be too hard on humans.
Enter Jack.
Jack is a CRNA, a nurse who does anesthesia. He was a paramedic for 20 years and by first impression a total prick but once I got to know him, I realized he was doing everything he could to make my OR experience as close to being in the field as possible.
So anyway, I spent most of two weeks struggling with a curved Mac Blade because it is supposed to be the easiest to use. The straight Miller was the evil bastard child that I'm not allowed to play with because he kicks puppies and pees on old ladies. After becoming increaslingly frustrated with the "easy" blade, I asked Jack for advice and he said to try the Miller, his favorite because of its simplicity.
With nothing to loose I gave the Miller a shot and listened as Jack told me: "Stick it in as far as it'll go, when it won't go any further, pull up and you should see the chords. None of that sissy footing like with the Mac, stick and pull." Just like that the vocal chords, those beautiful pearly gates to Paramedicdom dropped into view. Again and again.
I had been trying to get my ten tubes for close to six months, each attempt was met with either a failure or a problem, such as a massive fountain of blood and mucus (another story I'll have to write). But the straight blade's alarming simplicity proved to be a Godsend. Without the rotation and jerky movements of the Mac, I was able to successfully entubate all of my subsequent attempts. Just for the hell of it, I tried the Mac several more times, each time surprisingly I managed to hit my mark and entubate my patients.
Tubes are what makes a paramedic a paramedic, we need to be proficient in entubations because, as those who have been following these articles know, airway is the key to everything. A patient's leg can have a beautiful splint, he can have fantastic IV access but if hes blue, who cares?