Do You Feel Discomfort After A Intubating?

When I started as a respiratory therapist, I was nervous about intubating more than anything. You know exactly what to do. But when the time comes, and when the adrenaline is rushing through your veins, will you be able to do it right? And after the intubation you beat yourself over the head because you didn't live up to your own expectations. 

And, the key words in that above paragraph are put in italics and bold. They are your own expectations. If you are like me (and I'm sure you are) you yearn to be perfect. And anything less than that is unacceptable. And, if you do not live up to your own expectations while intubating, you eat yourself alive over it after the intubation. 

Here, I will give you some examples of things that may happen during the intubation process. 

"John, you forgot to inflate the cuff." 

You inflate it quickly.

"John, the E-Tab goes over the ETT, not under it." 

And you flip it over and do it right. 

In the past, when I did such blunders, I'd leave the intubation feeling like I did a bad job. I would worry what others were thinking about me. I would hit myself over the head, so to speak. 

And then I would create a plan to how I would remember to do it "PERFECT" next time. 

And, of course, the next intubation things things might go perfectly. But, chances are, that they will not go perfectly, and you will again have to deal with the voices in your head that say, "Dummy! Why did you do that?"

Now, fast forward 25 years. Now I know that it is completely normal do fumble during an intubation. I came to that realization at about the five year point of my career. But the beating myeslf over the head did not stop at that point. It stopped when, after 12 years on the job, I was promoted to day shift. And, rather than working by myself, I had a coworker to share duties with. 

And, my co-worker and I were at an intubation. 

The coworker I am referring to here has about ten more years of experience than me. She would often say things like, 'It's not my first Rodeo." And I watched at this intubation as she put the E-Tab on the patient upside down. She even went as far as to stick it to the patient's face. And the nurse said, "Doesn't that need to go the other way." And my coworker said, "Even after 20 years on the job I still goof up at times." And she proceeded to un-secure it from the patient's face and re-secure it on the right way. 

And my coworker said after the intubation, "Even senior RTs goof up at times." And she laughed it off and went about her business. 

From that point on I no longer beat myself over the head when I do not get an intubation perfect. I realize now that I am not the only one to make blunders like this. 

But, when I do make such a blunder,  I still do make a strategy in my mind how I will get it correct the next time. For example, I decided just recently that the E-Tab has to go on top of the ETT not the bottom. So, now when there is an intubation, I will get it right. And, making corrections like this is normal. It is the sign of a good RT. 

Another thing that happened recently was receive a patient who was on a ventilator from the night shift respiratory therapist. And the first thing I observed was that the E-Tab was upside down. See, I am not the only one to do this from time to time. We all make these subtle types of mistakes. You brush it off and move on. 

In the end it always get's done. Does it not? In the end, the patient is intubated and put on a ventilator and you go on to finish your shift. Now, whether you continue to have anxiety over how the intubation went is a matter of how much experience and confidence you have. If you are a new RT and you are a good RT, you will go over the code and probably stress about this or that that you did right or wrong. That is perfectly normal. And, I think, a sign of a good RT. That means you care. 

But, after a while, you will learn 3 things: 

1. Everyone fumbles at times. And not just RTs. Nurses and doctors do it too.  
2. To brush it off and move on when you do goof up. 
3. No one is thinking, "Oh my God, John screwed up!" No. They are thinking about what THEY did right or wrong at the intubation. 

And this brings up another interesting point. No one is looking you worrying about what you are doing or not doing. To think this is to think that others are so well adjusted that they are more concerned about you than their own selves. The truth to the matter is, people are inclined to wonder what YOU are thinking of them. This is natural. This is what we all do.